A cerebral contusion is traumatic bruising of brain parenchyma containing variable haemorrhage, oedema and tissue necrosis.

Common locations are:

because the brain impacts irregular surfaces of the skull base.

Contusions can occur at:

Coup site

Directly beneath impact.

Contrecoup site

Opposite the impact as the brain moves within the skull.

A major clinical characteristic is haemorrhagic progression, often called contusion blossoming.

A relatively small lesion on initial CT can enlarge significantly during the first hours after trauma.

Noncontrast CT: first line investigation.

The important features are:

Repeat CT is warranted with:

MRI can demonstrate nonhaemorrhagic components and associated axonal injury but is not required for immediate surgical decisions.

Small contusions without neurological deterioration or significant mass effect can be managed with:

Correct:

Reverse clinically significant anticoagulation promptly when haemorrhage is expanding or surgery may be required.

Surgery

Operate when a parenchymal lesion produces:

Specific operative thresholds include:

GCS 6 to 8 plus frontal or temporal contusion greater than approximately 20 cm³

with either:

or

Also operate for:

Any traumatic parenchymal mass lesion greater than approximately 50 cm³, particularly when producing significant mass effect.

Procedure

Perform craniotomy and evacuate the haemorrhagic contused tissue causing mass effect while preserving viable cortex where possible.

A large decompressive craniectomy can be added when severe swelling prevents safe bone flap replacement.

Avoid unnecessarily aggressive removal of nonexpansile contused brain simply because it appears abnormal on CT.

Refractory swelling

Persistent intracranial hypertension after focal evacuation requires:

Cerebral Contusion

Overview