| Print Date: | May 19, 2013, 10:07 pm |
| Title | 1. Bilateral frontal / temporal lobe hemorrhagic and nonhemorrhagic contusions 2. Skull fractures; coronal and sagittal suture diastasis 3. Possible basal skull fracture 4. Transtentorial herniation w/ resultant left posterior cerebral artery infarction 5. Bilateral subperiosteal orbital hematomas. |
| Text | Clinical findings in patients with contusions are related to the extent, multiplicity, and location of lesions. Many patients have only a brief period of unconsciousness unless the contusions are large, bilateral, associated with severe mass effect, or found in the conjunction with other traumatic brain lesions (DAI, brain stem injury, intracerebral hematoma). As compared to DAI and primary brain stem injury, contusions are much less likely to be associated with severe initial impairment of consciousness. Symptoms are usually more profound or obvious if lesions involve the speech or motor cortex. When cerebral contusions are large or extensive, they may act as "mass lesions." This can then produce "secondary injuries" of other portions of the brain due to increased intracranial pressure, herniation syndromes, and pressure necrosis of contiguous structures. Initially, the mass effect from contusions may be minimal. Mass effect invariably increases after injury because of progressive development of intracellular and interstitial edema until it becomes maximal at about 4-7 days.
This case illustrates two common sequelae (secondary injuries) of severe cortical contusions that can arise because of progressive development of mass effect from associated edema: 1. transtentorial herniation with secondary brain stem injury; and 2. posterior cerebral artery infarction due to transtentorial herniation. The latter complication arises as a result of compression of posterior cerebral artery between brain stem, medially herniated temporal lobe, and the sharp edge of the tentorium as this vessel crosses through the tentorial incisura. Other common sequelae include delayed intracerebral hematomas, secondary brain stem hemorrhages, and arterial vasospasm. Delayed hemorrhages of significant size are seen in 2-19% of patients. A repeat CT scan can be quite useful in patients who have a deterioration of clinical symptoms in order to differentiate among the various types of secondary lesions. Although contusions are best diagnosed by MRI, they are usually visible on CT scans. The contusions often become more obvious on delayed CT scans as the hypodensity from cellular necrosis and edema increases over the first few days after injury. |
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| Contributor | Neuroradiology Learning File - © ACR (ACR Learning File®) |
| Author | Lindell R. Gentry, MD |
| Peer Reviewer | James G. Smirniotopoulos, M.D. (Uniformed Services University) |
| Record Number | : 1546 |
| Created | 2001-03-27 13:19:38-05 |
| Modified | 2001-08-07 22:08:44-04 |
| Category: | Trauma |
| Location: | Brain and Neuro |
| Sublocation: | None Selected |
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