Cerebral contusion 2963341 223847652 2008-07-06T03:28:48Z Delldot 476500 /* Cerebral lacerations */ + ref {{Infobox_Disease | Name = Cerebral contusion | Image = | Caption = | DiseasesDB = | ICD10 = {{ICD10|S|06|2|s|00}}, {{ICD10|S|06|3|s|00}} | ICD9 = {{ICD9|851}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }} '''Cerebral contusion''', Latin ''contusio cerebri'', a form of traumatic [[brain injury]], is a [[bruise]] of the [[brain]] tissue. Like bruises in other [[tissue (biology)|tissue]]s, cerebral contusion can be caused by multiple [[microhemorrhage]]s, small [[blood vessel]] leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries.<ref name="Khoshyomn04"> {{ cite journal |author=Khoshyomn S, Tranmer BI |title=Diagnosis and management of pediatric closed head injury |journal=Seminars in Pediatric Surgery |volume=13 |issue=2 |pages=80–86 |year=2004 |month=May |pmid=15362277 |doi= 10.1053/j.sempedsurg.2004.01.003 |url= }} </ref> The injury can cause a decline in mental function and may result in [[brain herniation]], a life-threatening condition in which parts of the brain are squeezed past parts of the skull.<ref name="Khoshyomn04"/> Treatment aims to prevent dangerous rises in [[intracranial pressure]], the pressure within the skull. Contusions are likely to heal on their own without medical intervention.<ref>Sanders MJ and McKenna K. 2001. ''Mosby’s Paramedic Textbook'', 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.</ref> ==Signs and symptoms== Contusion can present with weakness, lack of [[motor coordination]], [[numbness]], [[aphasia]], and [[memory]] and [[cognitive]] problems.<ref name="Kushner98"> {{ cite journal |author=Kushner D |title=Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment |journal=Archives of Internal Medicine |volume=158 |issue=15 |pages=1617–1624 |year=1998 |pmid=9701095 |doi= |url=http://archinte.highwire.org/cgi/content/full/158/15/1617 }} </ref> Signs depend on the contusion's location in the brain.<ref name="Kushner98"/> ==Causes== [[Image:Schädelbasis1.jpg|thumb|right|140px|The interior of the skull has sharp ridges by which a moving brain can be injured.]] Often caused by a blow to the head, contusions commonly occur in [[coup contrecoup injury|coup or contre-coup injuries]]. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact. Contusions occur primarily in the [[cerebral cortex|cortical]] tissue, especially under the site of impact or in areas of the brain located near sharp ridges on the inside of the skull. The brain may be contused when it collides with bony protuberances on the inside surface of the skull.<ref name="RaoLyketsos"> {{ cite journal |author=Rao V, Lyketsos C |title=Neuropsychiatric Sequelae of Traumatic Brain Injury |journal=Psychosomatics |volume=41 |issue=2 |pages=95–103 |year=2000 |pmid=10749946 |doi= }} </ref> The protuberances are located on the inside of the skull under the [[frontal lobe|frontal]] and [[temporal lobe]]s and on the roof of the [[orbit (anatomy)|ocular orbit]].<ref name="Shepherd">Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on [[2008-01-10]].</ref> Thus, the tips of the frontal and temporal lobes located near the bony ridges in the skull are areas where contusions frequently occur and are most severe.<ref>Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. ''Head Injury'', 4th Ed. Morgan Hill, New York.</ref> For this reason, attention, emotional and memory problems, which are associated with damage to frontal and temporal lobes, are much more common in [[head trauma]] survivors than are syndromes associated with damage to other areas of the brain.<ref name="Bigler">Bigler, ED. 2000. [http://web.archive.org/web/20041205062946/http://psych.byu.edu/work/tbi.pdf The Lesion(s) in Traumatic Brain Injury: Implications for Clinical Neuropsychology]. Accessed through web archive. Retrieved on [[2008-01-17]].</ref> ==Features== Contusions, which are frequently associated with [[edema]], are especially likely to cause increases in [[intracranial pressure]] (ICP) and concomitant crushing of delicate brain tissue. Contusions are also more likely to result in hemorrhage than is [[diffuse axonal injury]] because they occur more often in the cortex, an area with more [[blood vessel]]s.<ref name="GE Healthcare">{{Medcyclopaedia|vi_1/b/BRAIN_INJURY_TRAUMATIC}}</ref> Contusions typically form in a wedge-shape with the widest part in the outermost part of the brain.<ref name="Vinas and Pilistis">Vinas FC and Pilitsis J. 2006. [http://www.emedicine.com/med/topic2888.htm "Penetrating Head Trauma."] Emedicine.com. Retrieved on [[2008-01-10]].</ref> The distinction between contusion and [[intracerebral hemorrhage]] is blurry because both involve bleeding within the brain tissue; however, an arbitrary cutoff exists that the injury is a contusion if two thirds or less of the tissue involved is blood and a hemorrhage otherwise.<ref name="Khoshyomn04"/> The contusion may cause swelling of the surrounding brain tissue, which may be irritated by toxins released in the contusion.<ref name="Khoshyomn04"/> The swelling is worst at around four to six days after the injury.<ref name="Khoshyomn04"/> Extensive contusion associated with [[subdural hematoma]] is called '''burst lobe'''.<ref name="Gennarelli04"/> Cases of a burst frontal or temporal lobe are associated with high [[mortality rate|mortality]] and [[morbidity]].<ref name="Gennarelli04"/> ==Multiple petechial hemorrhages== Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called [[multiple petechial hemorrhage]]s or [[multifocal hemorrhagic contusion]].<ref name="GE Healthcare"/> Caused by [[shearing injury|shearing injuries]] at the time of impact, these contusions occur especially at the junction between grey and white matter and in the upper [[brain stem]], [[basal ganglia]], [[thalamus]] and areas near the third [[ventricular system|ventricle]].<ref name="GE Healthcare"/> The hemorrhages can occur as the result of [[brain herniation]], which can cause arteries to tear and bleed.<ref name="GE Healthcare"/> A type of [[diffuse brain injury]], multiple petechial hemorrhages are not always visible using current imaging techniques like CT and [[MRI]] scans. This may be the case even if the injury is quite severe, though these may show up days after the injury.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"]. Retrieved [[May 8]], [[2008]]</ref> Hemorrhages may be larger than in normal contusions if the injury is quite severe. This type of injury has a poor prognosis if the patient is [[coma]]tose, even with no apparent causes for the coma.<ref name="Downie"/> ==Cerebral lacerations== A '''cerebral laceration''' occurs when the tissue of the [[brain]] is mechanically cut or torn.<ref name="Hardman02"> {{ cite journal |author=Hardman JM, Manoukian A |title=Pathology of Head Trauma |journal=Neuroimaging Clinics of North America |volume=12 |issue=2 |pages=175–187, vii |year=2002 |pmid=12391630 |doi=10.1016/S1052-5149(02)00009-6 }} </ref> According to their respective definitions, the [[pia mater|pia]]-[[arachnoid mater|arachnoid]] membranes and are torn over the site of injury in laceration and are not torn in contusion.<ref name="Granacher07"> {{ cite book |author=Granacher RP |title=Traumatic Brain Injury: Methods for Clinical & Forensic Neuropsychiatric Assessment, Second Edition |publisher=CRC |location=Boca Raton |year=2007 |pages= 26|isbn=0-8493-8138-X |oclc= |doi= |accessdate=2008-07-06 |url= http://books.google.com/books?id=xt1YFydzXKQC&pg=PA32&lpg=PA32&dq=focal+diffuse+brain+injury+&source=web&ots=w7wP6GHZlC&sig=QTuqyJSaHrbwZvlVFClvDtEpEQk&hl=en&sa=X&oi=book_result&resnum=9&ct=result#PPA26,M1 }} </ref><ref name="Gennarelli04"> {{ cite book |author=Gennarelli GA, Graham DI |chapter=Neuropathology |editor= Silver JM, McAllister TW, Yudofsky SC |title=Textbook Of Traumatic Brain Injury |publisher=American Psychiatric Association |location=Washington, DC |year=2005 |pages= 29| isbn=1-58562-105-6 |oclc= |doi= |accessdate=2008-06-10 |url = http://books.google.com/books?id=3CuM6MviwMAC&pg=PA47&dq=neurotrauma&lr=&client=firefox-a&sig=7kXGu4v_cHPiZRFPwo2j7uIT-og#PPA27,M1 }} </ref> Lacerations require greater physical force to cause than contusions,<ref name="Hardman02"/> but the two types of injury are grouped together in the [[ICD-9]] and [[ICD-10]] classification systems. Frequently occurring in the same areas as contusions, lacerations are particularly common in the inferior [[frontal lobe]]s and the poles of the [[temporal lobe]]s.<ref name="Hardman02"/> When associated with [[diffuse axonal injury]], the [[corpus callosum]] and the [[brain stem]] are common locations for laceration.<ref name="Hardman02"/> Lacerations are very common in [[penetrating head injury|penetrating and perforating head trauma]] and frequently accompany [[skull fracture]]s; however, they may also occur in the absence of skull fracture.<ref name="Hardman02"/> Lacerations, which may result when brain tissue is stretched, are associated with intraparenchymal bleeding (bleeding into the brain tissue).<ref name="Hardman02"/> ==Treatment== Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of [[hypotension]] (low blood pressure), [[hyponatremia]] (insufficient sodium), and [[hypercapnia]] (excess [[carbon dioxide]] in the blood).<ref name="Khoshyomn04"/> Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it.<ref name="Khoshyomn04"/> People with cerebral contusion may require [[intensive care]] and close monitoring.<ref name="Khoshyomn04"/> <!-- ==Prognosis== ==Epidemiology== ==History== --> ==See also== * [[Traumatic brain injury]] * [[Brain damage]] * [[Concussion]] * [[Diffuse axonal injury]] * [[Intracranial hemorrhage]] * [[Intraparenchymal hematoma]] * [[Epidural hematoma]] * [[Subdural hematoma]] * [[Subarachnoid hemorrhage]] ==References== <references/> {{Injuries, other than fractures, dislocations, sprains and strains }} {{Neurotrauma}} [[Category:Neurotrauma]] [[lt:Galvos smegenų sumušimas]] [[nl:Hersenkneuzing]] [[ja:脳挫傷]]