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Closed Versus Open (Penetrating) Head Trauma


Contusion/Laceration (Including Coup and Contrecoup Lesions)

Definition

  • Direct injury to surface of brain parenchyma, usually involving the cortical gray matter

  • Contusion: a “bruise” of the brain with intact pia mater

  • Laceration: tearing of brain tissue with breached pia mater

Clinical Features

Epidemiology

  • Traumatic brain injury caused 6.5% of deaths in the United States

  • Frequency is approximately 32 per 100,000 persons

  • Twice as frequent in children than adults

  • Highest number occurs between the ages of 15 to 24 years

  • Occurs more frequently in males

  • Contusions in 45% primary intra-axial traumatic lesions

  • Caused by direct or indirect trauma from linear acceleration or deceleration forces

  • Associated with motor vehicle collisions, falls, industrial and recreational accidents, assaults

Presentation

  • Most common early clinical symptom is confusion

  • Focal neurologic deficits vary depending on location of lesion

  • Loss of consciousness is less common than with diffuse axonal injury; see Diffuse Axonal Injury (Diffuse Traumatic Brain Injury)

Treatment/Prognosis

  • Emergent evacuation of associated hematoma if symptoms are life threatening

  • Mitigating secondary effects such as increased intracranial pressure and perfusion disturbances

Imaging Characteristics

  • Patchy superficial hemorrhages with associated edema

  • May occur at the site of adjacent skull fracture

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