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Cerebral Contusion

Cerebral contusion is a brain bruise usually resulted from a strong, direct blow to the head. Cerebral laseration is torn brain tissue, frequently accompanied skull fracture and visible wound of the head. Cerebral contusion and laceration are more severe than concussions. More serious than a concussion, contusion disrupts normal nerve functions in the bruised area and may cause loss of consciousness, hemorrhage, edema, and even death.

Causes

Cerebral contusion results from acceleration deceleration or coup-contrecoup injuries. Such injuries can occur directly beneath the site of impact when the brain rebounds against the skull from the force of a blow (a beating with a blunt instrument, for example), when the force of the blow drives the brain against the opposite side of the skull, or when the head is hurled forward and stopped abruptly (as in an automobile accident when a driver's head strikes the windshield).

When these injuries occur, the brain continues moving and slaps against the skull (acceleration), then rebounds (deceleration). These injuries can also cause the brain to strike against bony prominences inside the skull (especially the sphenoidal ridges), causing intracranial hemorrhage or hematoma that may result in tentorial herniation.

Signs and symptoms

With cerebral contusion, the patient may have severe scalp wounds and labored respirations. He may lose consciousness for a few minutes or longer. If conscious, he may be drowsy, confused, disoriented, agitated, or even violent. He may display hemiparesis, decorticate or decerebrate posturing, and unequal pupillary response.

Eventually, he should return to a relatively alert state, perhaps with temporary aphasia, slight hemiparesis, or unilateral numbness. A lucid period followed by rapid deterioration suggests epidural hematoma.

Diagnosis

An accurate history of the trauma and a neurologic examination are the principal diagnostic tools. A computed tomography scan shows ischemic tissue, hematomas, and fractures. Intracranial hemorrhage contraindicates lumbar puncture.

Treatment

The treatment for a contusion is usually to watch the person closely for any change in level of consciousness. The person may need to stay in the hospital for close observation. Surgery is usually not necessary. Headache and dizziness are common, but if the headache persists or becomes severe, it is best to seek medical attention.

It is important to keep in mind that recovery from a traumatic brain injury can be very slow. Sometimes several days can go by without seeing any major visible change. This is not unusual, and it is best to ask the health-care providers if any changes have occurred. It is also important to try to get enough rest and nutrition while waiting for the patient to recover. It is normal to feel frustrated, overwhelmed, lonely and worried. Sometimes a friend, or support group can help. Before your stress gets out of control, tell someone who can help.