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Brain Contusion

Brain contusion, defined as superficial bruising of the brain, is one of the most common forms of traumatic brain injury (TBI). Motor vehicle accidents, sports activities and intentional injuries in the form of blunt force trauma are possible causes. Depending on the severity of contusion, individuals may present with a variable degree of altered consciousness and neurological deficits. Imaging studies and assessment of the Glasgow Coma Scale (GCS) are necessary to make the diagnosis.


Presentation

Traumatic brain injury (TBI) is regarded as one of the most troubling forms of trauma, having in mind that about 50% of all survivors suffer from long-term physical, cognitive, emotional or behavioral sequelae [1]. Focal injuries of the brain occurring after interaction with the skull (most frequently with the inferior frontal lobes, frontal poles and the inferior temporal lobes) are known as contusions, which may be further complicated by herniation, hemorrhage, the formation of intracerebral hematomas, or laceration of the brain [2] [3]. Moreover, contusions are classified as coup or contrecoup lesions, suggesting whether the brain injury developed at the site of impact (coup) or at the opposite pole (contrecoup), often being more severe [2] [4]. Motor vehicle accidents are, by far, the most common cause of TBI and contusions, while blunt force trauma and sports activities are also important mechanisms of trauma [1] [4]. Regardless of the type of injury, the clinical presentation solely depends on its severity. Milder contusions usually do not cause any focal neurological deficits, while moderate and severe trauma can cause marked changes in the level of consciousness (lethargy, stupor, and coma are possible manifestations) and overall responsiveness of the patient [4] [5] [6]. One of the most important features of contusions is their frequent enlargement in the hours following the injury, leading to potentially severe and life-threatening neurological deterioration in the absence of an early diagnosis, suggesting that timely recognition of trauma and confirmation of a brain contusion is detrimental in order to achieve a good long-term outcome [5] [6].

Italian
  • […] brain contusion, Brain contusion, Contusion of brain (diagnosis), head injury contusion of brain, Contusion of brain, Contusional brain injury, Contusion of brain (disorder), brain; contusion, contusion; brain, Contusion of brain, NOS, Brain Contusion Italian[fpnotebook.com]
Nightmare
  • This condition disrupts their daily lives, with the possible consequences : chronic stress excessive vigilance physical complaints reliving of the trauma nightmares / night Terrors fears This situation needs to be treated by experienced neuro - psychologists[braininjury-explanation.com]
Vomiting
  • Symptoms Of Cerebral Contusions Vomiting, severe headaches, loss of memory, confusion, drowsiness, and weakness are all indications that one may have a cerebral contusion.[kirkendalldwyer.com]
  • Symptoms and signs associated with severe injury to the brain include excruciating headache accompanied by nausea and vomiting, increase in size or uneven size of the pupils of the eyes, long period of unconsciousness, confusion, agitation or tiredness[ic.steadyhealth.com]
  • Nausea and vomiting accompanied with seizures. Difficulty in coordination of movements. Some individuals may also experience difficulty in hearing, vision or speech.[tandurust.com]
  • Mild symptoms of a brain contusion can include a brief loss of consciousness, dizziness, feeling confused, headache, tiredness, and nausea and/or vomiting.[study.com]
  • If the initial impact results in swelling, additional signs of more serious bruising may include impaired speech, seizure, and persistent nausea, vomiting and headache.[wisegeek.com]
Nausea
  • Symptoms and signs associated with severe injury to the brain include excruciating headache accompanied by nausea and vomiting, increase in size or uneven size of the pupils of the eyes, long period of unconsciousness, confusion, agitation or tiredness[ic.steadyhealth.com]
  • Nausea and vomiting accompanied with seizures. Difficulty in coordination of movements. Some individuals may also experience difficulty in hearing, vision or speech.[tandurust.com]
  • Mild symptoms of a brain contusion can include a brief loss of consciousness, dizziness, feeling confused, headache, tiredness, and nausea and/or vomiting.[study.com]
  • If the initial impact results in swelling, additional signs of more serious bruising may include impaired speech, seizure, and persistent nausea, vomiting and headache.[wisegeek.com]
  • Nausea and vomiting. Weakness.[quizlet.com]
Loss of Appetite
  • Some may exhibit accentuated crankiness, a loss of appetite, or pronounced behavioral and sleep changes.[wisegeek.com]
Back Pain
Low Back Pain
Seizure
  • Leading causes were headache followed by seizure and dizziness. Rehospitalization was increased in the patients with altered level of consciousness.[ncbi.nlm.nih.gov]
  • Those who have sustained significant bruising may develop seizures, impaired cognition, or nerve damage that results in temporary or permanent paralysis.[wisegeek.com]
  • She said Hayden was medically sedated Tuesday after having seizures. He has a skull fracture and a brain contusion, but no other injuries.[thecabin.net]
  • Nausea and vomiting accompanied with seizures. Difficulty in coordination of movements. Some individuals may also experience difficulty in hearing, vision or speech.[tandurust.com]
Amnesia
  • Other signs of mild trauma may include impaired sensory perception, temporary confusion or amnesia, and personality changes.[wisegeek.com]
  • We include athletes who have lost consciousness for more than five minutes or experienced amnesia for more than 24 hours in the Grade 5 category.[brighamhealthhub.org]
  • This is the period of posttraumatic amnesia. The longer the duration of amnesia, the more severe the brain damage.[msktc.org]
  • Severity Structural Imaging ( MRI , CT ) Loss of Consciousness Alteration of Consciousness Posttraumatic amnesia (PTA) Glasgow Coma Scale (GCS) Mild Normal 0–30 min ( Moment 13–15 Moderate Normal or Abnormal 30 min but 24 hours 1–7 days 9–12 Severe Normal[minclinic.ru]
  • The patient began to follow commands at day 5, but he remained in posttraumatic amnesia for several weeks. Memory dysfunction and deficits in executive control persisted throughout the acute rehabilitation period.[journals.lww.com]
Stroke
  • Abstract Recent studies have demonstrated that peroxisome proliferator-activated receptor-alpha (PPAR-alpha) agonists can protect the brain against excessive oxidative stress and inflammation in traumatic brain injury (TBI) and stroke through endogenous[ncbi.nlm.nih.gov]
  • Cerebral Infarction/Stroke When a blood clot blocks the blood flow to the brain, a person has an ischemic stroke. This type of stroke is also called a cerebral infarction or brain attack.[finr.net]
  • The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors.[neurosurgery.ucla.edu]
  • Resources: National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No.: 02-158.[biau.org]
Personality Change
  • Other signs of mild trauma may include impaired sensory perception, temporary confusion or amnesia, and personality changes.[wisegeek.com]
  • S EQUELA Possible sequelae are divided into categories : physical problems emotional and personality changes motoric disorders psycho - social problems cognition (see list below for cognitive impairment ) After a TBI, neurons (nerve cells) in the brain[braininjury-explanation.com]
  • Patients with serious closed head injuries may suffer from: Seizures Nerve damage Cognitive disabilities Communication difficulties Personality changes Changes in sensory perception Post-concussion syndrome Coma Most patients suffering from mild closed[allabouttbi.com]
Stupor
  • Milder contusions usually do not cause any focal neurological deficits, while moderate and severe trauma can cause marked changes in the level of consciousness (lethargy, stupor, and coma are possible manifestations) and overall responsiveness of the[symptoma.com]
  • […] and coma, coma 1 hour with mcc 083 Traumatic stupor and coma, coma 1 hour with cc 084 Traumatic stupor and coma, coma 1 hour without cc/mcc 955 Craniotomy for multiple significant trauma 956 Limb reattachment, hip and femur procedures for multiple significant[icd10data.com]
  • Confusing and ambiguous terms such as "stupor", "lethargy", and "coma" should be avoided unless defined. Decreasing levels of consciousness often follow a logical progression and can be documented in a stepwise pattern (Table 29-1 ).[dartmouth.edu]

Workup

A thorough diagnostic workup of all head traumas is absolutely necessary, starting with a detailed patient history that will identify the type, severity and exact site of injury. As patients can often present with altered consciousness, it is advised to obtain data from friends or family members, after which a thorough clinical examination is necessary. In all patients with suspected TBI, the GCS score must be calculated, composed of three components - verbal response, eye-opening, and motor function [3] [5]:

  • Best verbal response - Patients may be oriented (5), confused (4), speak incomprehensible words (3), mumble (2) or do not have a response of any kind (1).
  • Eye opening can occur spontaneously (4), only to speech (3) or pain (2), while most severe injuries cause a complete loss of this function (1).
  • Obeying of commands ordered by the physician (6), a localized purposeful response after pain stimulation (5), withdrawal after pain stimuli, abnormal flexion (3) or extension (2) after pain or no response at all (1) are motor response categories of the GCS.

The importance of GCS lies in the assessment of further diagnostic steps and the prognosis, as patients with a lower GCS score (moderate TBI is scaled from 9-13, while severe TBI is assumed when GCS scores are 3-8) are at a much great risk for clinical deterioration and the development of complications. For this reason, immediate employment of imaging studies is vital [2] [4] [5]. Noncontrast computed tomography (CT) is recommended as first-line, as it is able to identify signs of hemorrhage in all parts of the brain, whereas magnetic resonance imaging (MRI), although limited in the acute setting because of its inability to recognize hemorrhagic lesions in the first several hours after trauma, is recommended for more complex injuries that require additional workup [2] [4] [5].

Brain Edema
  • Studies show that brain swelling, after traumatic brain injury (TBI), is caused by brain edema rather than cerebral blood volume (CBV). CBV is reduced in proportion to cerebral blood flow (CBF) reduction, following a severe TBI.[ncbi.nlm.nih.gov]
  • Blood loss from multiple injuries and, as mentioned, brain edema further compromise delivery of oxygen to the brain.[dartmouth.edu]

Treatment

  • Our human data largely parallel experimental findings in rats, indicating that such trauma models are relevant for experimental studies and treatment trials.[ncbi.nlm.nih.gov]
  • Treatment For Cerebral Contusion In cases of minor brain contusion, no specific treatment is required and these contusions tend to heal spontaneously.[tandurust.com]
  • Treatment for Brain Contusion It is essential to make quick diagnosis of brain contusion. Furthermore, it is essential to identify the underlying cause.[ic.steadyhealth.com]

Prognosis

  • RESULTS: The favorable prognosis rate in Group I, II and III was higher than Group IV on 6-month follow-up Glasgow Outcome Score (GOS).[ncbi.nlm.nih.gov]
  • The importance of GCS lies in the assessment of further diagnostic steps and the prognosis, as patients with a lower GCS score (moderate TBI is scaled from 9-13, while severe TBI is assumed when GCS scores are 3-8) are at a much great risk for clinical[symptoma.com]
  • Contusion alone did not worsen the prognosis of patients in short term follow up and did not cause neurosurgical interventions. Read more about Effects of brain contusion on mild traumatic brain injured patients[noninvasiveicp.com]
  • The prognosis of cerebral contusion depends upon a host of factors including the severity of the injury and the stage of medical intervention.[tandurust.com]

Epidemiology

  • Cerebral Contusion Epidemiology Causes Direct hit to the head. Acceleration-deceleration injury.[quizlet.com]
Sex distribution
Age distribution

Pathophysiology

  • It is concluded that TBI could greatly upregulate the binding activity and protein expression of PPAR-alpha in injured human brain, which might be important in brain pathophysiology after TBI.[ncbi.nlm.nih.gov]
  • The pathophysiological mechanisms following traumatic brain injury. Rev Assoc Med Bras 2009;55:75-81. [ Links ] 2. Ståhl N, Nordström CH. Brain energy metabolism during controlled reduction of cerebral perfusion pressure in severe head injuries.[scielo.br]
  • […] of Consciousness Alteration of Consciousness Posttraumatic amnesia (PTA) Glasgow Coma Scale (GCS) Mild Normal 0–30 min ( Moment 13–15 Moderate Normal or Abnormal 30 min but 24 hours 1–7 days 9–12 Severe Normal or Abnormal 24 hrs 24 hours 7 days 3–8 Pathophysiological[minclinic.ru]
  • […] coup, contra-coup injury) if resulting from acceleration/deceleration type injury May occur with other intracranial injuries such as skull fractures, subdural or epidural bleeding Size can vary from millimeters to several centimeters Cerebral Contusion Pathophysiology[quizlet.com]

Prevention

  • Administration of FVII prevented the progression of hemorrhaging from cerebral contusions by protecting microvessel endothelial cells in the penumbra of the contusion.[ncbi.nlm.nih.gov]
  • Supplementary oxygen is essential to prevent hypercapnia, due to suppressed breathing. Intensive care monitoring of patients with cerebral contusion is essential to prevent onset of grave complications.[tandurust.com]
  • Surgery allows physicians to reduce swelling caused by the bruising and prevent further damage. Doctors will also use antibiotics to treat infections in the body that may increase the swelling.[consumerdangers.com]
  • Those which have had a substantial impact to the head as a result of safety negligence at a worksite, such as a construction site where the head gear was non-sufficient to prevent injury, may have grounds for a claim.[tylers-solicitors.co.uk]
  • Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it.[braininjury-explanation.com]

References

Article

  1. Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review. J Neurotrauma. 2012;29(1):19-31.
  2. Kim JJ, Gean AD. Imaging for the Diagnosis and Management of Traumatic Brain Injury. Neurotherapeutics. 2011;8(1):39-53.
  3. MCKee AC, Daneshwar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol. 2015;127:45-66.
  4. Lee B, Newberg A. Neuroimaging in Traumatic Brain Imaging. NeuroRx. 2005;2(2):372-383.
  5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  6. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.

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Last updated: 2019-06-28 12:17