Traumatic Brain contusions

- Introduction

Cerebral contusion is the classic example of focal traumatic brain injury (TBI). Before evolution of the CT, cerebral contusion could be diagnosed only in the operating room or during autopsy. Thus, contusion was considered only in cases of severe TBI and was therefore thought to be associated with severe injury.² Since the advent of CT, contusions have commonly been observed in patients with mild and moderate TBI. It is now recognized that there is a wide range of severity associated with cerebral contusion.³

Tiny punctate contusions in patients with mild TBI have little or no clinical significance . At the other end of the spectrum, large contusions with significant mass effect in patients with severe TBI can be life-threatening and need emergent intervention.⁴

Contusions can be classified as coup or contrecoup injuries. Coup contusions occur at the location of impact, whereas contrecoup contusions occur on the opposite side or at a point distant from the impact.⁵

Frontal and temporal lobes are the most common sites for brain contusion. However, brain contusion can be present in any site in the brain.⁶

Contusions often enlarge during the first week after injury. Repeated CT should be considered if the patient shows clinical deterioration. ⁷

Surgery may be necessary to resect areas of contused brain if there is significant mass effect with raised ICP. Temporal lobe contusions are particularly ominous because of their proximity to the brainstem and risk of herniation.⁸