Simply explained, a brain contusion is a bruise of the brain tissue. Just like bruises that occur on other parts of the body, a brain contusion is caused by small blood vessel leaks. Because they involve structural brain damage, contusions are more serious than concussions.
Cerebral contusion (contusio cerebri) is a form of traumatic brain injury, a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries. A cerebral laceration is a similar injury except that, according to their respective definitions, the pia-arachnoid membranes are torn over the site of injury in laceration and are not torn in contusion.
The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull.
Contusions often heal on their own without further medical intervention.
Main causes of brain contusions
Brain contusions are most often caused by an impact to the head, such as those sustained in a car accident, a fall, or a sports-related accident. In some cases the brain is injured right below the site of impact, while in other cases the injury occurs on the opposite side of the impact.
Contusions are most often found in cortical tissue, in areas that are near sharp ridges on the inside of the skull, such as under the frontal and temporal lobes and on the root of the ocular orbit.
What are the signs and symptoms of contusion cerebri
Contusions can be very minor with few symptoms and little or no damage to the brain, or they can be quite severe. People with severe contusions often spend some time unconscious following the injury, and upon awaking are confused, tired, emotional, or agitated. More severe contusions lead to swelling in the brain, which can cause additional brain damage.
Other symptoms of brain contusions may include:
• Memory loss
• Attention problems
• Emotional disturbances
• Difficulty with motor coordination
• Numbness
• Loss of ability to understand or express speech
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 typically form in a wedge-shape with the widest part in the outermost part of the brain.
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.
The contusion may cause swelling of the surrounding brain tissue, which may be irritated by toxins released in the contusion. The swelling is worst at around four to six days after the injury.
Extensive contusion associated with subdural hematoma is called burst lobe. Cases of a burst frontal or temporal lobe are associated with high mortality and morbidity.
Old or remote contusions (often referred to as plaque jaune or yellow plaque) 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.
Multiple petechial hemorrhages
Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhages or multifocal hemorrhagic contusion. 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.
The hemorrhages can occur as the result of brain herniation, which can cause arteries to tear and bleed. 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. 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 comatose, even with no apparent causes for the coma.
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