n+Neurology

Cerebral Contusion

KEY FACTS

TERMINOLOGY

• Brain surface injuries involving gray matter and contiguous

subcortical white matter

IMAGING

• Best diagnostic clue: Patchy hemorrhages within

edematous background

• Characteristic locations: Adjacent to irregular bony

protuberance or dural fold

• Anterior inferior frontal lobes and anterior inferior

temporal lobes most common

• FLAIR: Best for hyperintense cortical edema and

subarachnoid hemorrhage

• GRE: Hypointense hemorrhagic foci "bloom"

• Best imaging tool

○ CT to detect acute hemorrhagic contusions, other

intracranial lesions, and herniations

○ MR to detect presence and delineate extent of lesions

• Coup: Direct injury to brain beneath impact site

• Contrecoup: Injury opposite impact site; usually more

severe than coup

TOP DIFFERENTIAL DIAGNOSES

• Infarct

• Venous sinus thrombosis

• Cerebritis

• Low-grade neoplasm

• Transient postictal changes

PATHOLOGY

• Inflammation → worsening/enlarging lesions

CLINICAL ISSUES

• Initial symptom: Confusion → obtundation

• Central goal: Prevent and treat secondary injury

• Mass effect and herniation may require evacuation

(Left) Coronal graphic

illustrates the pathology of

closed head injury. Note the

hemorrhagic foci involving

gray matter of several

contused gyri ﬈, axonal and

deep gray injuries, and

traumatic subarachnoid

hemorrhage ﬊ in the basal

cisterns and sylvian fissure.

(Right) Graphics depict the

most common sites of cerebral

contusions in red. Less

common sites are shown in

green. The most common

locations of all are the

anteroinferior frontal and

temporal lobes.

(Left) Gross pathology of the

brain from a patient who died

from a severe closed head

injury shows bifrontal,

temporal hemorrhagic

contusions ﬈, as well as

traumatic subarachnoid

hemorrhage in the suprasellar

cistern ﬊. (Courtesy R.

Hewlett, MD.) (Right) NECT

scan shows extensive

frontotemporal contusions ſt

and traumatic subarachnoid

hemorrhage ﬇ in a patient

with severe brain injury.

Trauma, and Stroke

Brain: Pathology-Based Diagnoses: Malformations,

45