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.
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 . 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  . 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  . 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  . 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   . 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  .
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  :
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   . 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   .