Cerebral Contusion

More serious than a concussion, a cerebral contusion is an ecchymosis of brain tissue that results from a severe blow to the head. A contusion disrupts normal nerve functions in the bruised area and may cause loss of consciousness, hemorrhage, edema, and even death.

Causes

A cerebral contusion results from acceleration­deceleration or coup-contrecoup injuries. It is also seen in child, spouse, and elder abuse.

A cerebral contusion can occur directly beneath the site of impact (coup) when the brain rebounds against the skull from the force of a blow (a beating with a blunt instrument, for example), when the force of the blow drives the brain against the opposite side of the skull (contrecoup), or when the head is hurled forward and stopped abruptly (as in a motor vehicle crash when the driver's head strikes the windshield). The brain continues moving and slaps against the skull (acceleration) and then rebounds (deceleration).

Signs and symptoms

The signs and symptoms of a contusion include severe headache, dizziness, vomiting, increased size of one pupil or sudden weakness in an arm or leg. The person may seem restless, aggitated or irritable. Often, the person may have memory loss or seem forgetful. These symptoms may last for several hours to weeks, depending on the seriousness of the injury. Any period of loss of consciousness or amnesia of the head injury should be evaluated by a health-care professional. As the brain tissue swells, the person may feel increasingly drowsy or confused. If the person is difficult to awaken or passes out, medical attention should be sought immediately. This could be a sign of a more severe injury.

Diagnostic tests

Cerebral angiography outlines vasculature, and a computed tomography (CT) scan shows ischemic or necrotic tissue, cerebral edema, areas of petechial hemorrhage, and subdural, epidural, and intracerebral hematomas. A CT scan also may reveal a shift in brain tissue.

Treatment

Immediate treatment may include establishing a patent airway and, if necessary, tracheotomy or endotracheal intubation. Treatment also may consist of careful administration of I.V. fluids (lactated Ringer's or normal saline solution), I.V. mannitol to reduce ICP, and restricted fluid intake to decrease intracerebral edema. Dexamethasone may be given I.M. or I.V. for several days to control cerebral edema.

The patient's ICP may be reduced by maintaining his partial pressure of arterial carbon dioxide (Paco2) between 30 and 35 mm Hg. Accomplish this by adjusting the ventilator settings for an intubated patient. A decreased Paco2 constricts cerebral blood vessels and reduces cerebral blood flow, thus reducing ICP. Serial arterial blood gas studies allow monitoring of oxygenation.

If necessary, additional treatments may include blood transfusion and craniotomy to control bleeding and aspirate blood.

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