Notes from Dr. Borkosky

Causes of Brain Contusions. Ultra-rapid stretch causes failure of the viscoelastic properties of axons. People may need to be sedated because too much muscle activity can increase the pressure in the brain and further affect brain function. A sketch illustrating the main steps of traumatic (diffuse) axonal injury, from top to bottom. In head--injured patients, the rise in intracranial pressure (ICP), subsequent to uncontrollable swelling, is the only and the most frequent cause of death. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. 2008;25 (5): 503-12. In most hospitals, CT is usually the first and often the only investigation used to assess cerebral contusions. Red arrows indicate some of the numerous microbleeds that are heme-positive and magnetic-field distorting lesions. Cerebral contusions are scattered areas of bleeding on the surface of the brain, most commonly along the undersurface and poles of the frontal and temporal lobes. 2016 Oct;25(2):306-19. doi: 10.1007/s12028-016-0253-y.

Histologically the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the cortical contusion and bilaterally in diffuse axonal injury. Correlation of diffusion MRI findings with lesion progression in patients with traumatic intracerebral hemorrhage : diffusion MRI in traumatic intracerebral hemorrhages with progression.

[5], Old or remote contusions are associated with resorption of the injured tissue, resulting in various degrees of cavitation, in addition to the presence of a golden-yellow discoloration due to residual hemosiderin. Cerebral contusions are frequently associated with intracranial mass lesions, although they may occur as a result of the coup‐contrecoup phenomenon, especially in the temporal and inferior frontal regions. However, because neuronal proteins undergoing fast anterograde transport, including neurofilament proteins and amyloid precursor protein (APP), accumulate in damaged axons, immunohistochemistry for these proteins has largely replaced silver methods in recent years. Thus, contusion was considered only in cases of severe TBI and was therefore thought to be pathognomonic for severe injury. [14] Caused by 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 ventricle. 21.4).

Typically they mature over some weeks, initially appearing as merely hemorrhagic foci, followed by the development of surrounding edema, before gradually fading away leaving behind more or less distinct areas of gliosis. Cerebral contusions are fairly common, found in 8% of all TBI cases14,42 and 13% to 35% of severe injuries.14 Contusions of the brain are often concomitant with SDH. Management of the intracerebral hematoma is dependent on the neurologic status of the patient. Typical causes include motor vehicle accidents or situations in which the head strikes the ground.

The former condition may either leave the axonal structure intact or in fact lead to microtubule polymerization and fast axonal growth during development, whereas the latter condition causes multiple-site breakage of microtubules leading to undulations, swellings, and axon bulbs (Figs. Thus seizures, often focal, motor deficits, especially hemiparesis or monoparesis, and deviation of eyes to the side of the lesion (but movable with the “doll's eyes” maneuver) represent particularly characteristic cerebral signs. A contusion happens when an injured capillary or blood vessel leaks blood into the surrounding area. In the pericontusional zone and surrounding parenchyma, vasoresponsivity may be nearly three times normal, which suggests hypersensitivity to hyperventilation and other phenomena.

Also in patients with GCS scores of 6 to 8 with frontal or temporal contusion greater than 20 cm3 with midline shift greater than 5 mm or cisternal compression on CT scan, and patients with any lesion greater than 50 cm3 in volume should be surgically treated.10.

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