Brain Contusion: Traumatic Brain Injury Type, Symptoms, and Management

A cerebral contusion is a bruise of brain tissue—focal hemorrhage and edema from mechanical impact causing microvascular rupture. It is a focal traumatic brain injury (TBI), distinct from diffuse axonal injury.

Mechanism

• Coup injury: Direct impact site (brain strikes inner skull).
• Contrecoup injury: Opposite side (brain rebounds); often more severe (frontal/temporal poles).
• Common sites: Frontal/temporal tips, orbital roof, frontal operculum.

Clinical Presentation

• Altered consciousness (GCS variable)
• Focal deficits (hemiparesis, aphasia, visual field cut)
• Seizures (early <7d, late >7d)
• Headache, nausea, vomiting, cognitive slowing
• May worsen over 24–48h as edema peaks

Imaging

• CT (acute): Hyperdense foci (acute blood) ± surrounding hypodense edema. "Salt-and-pepper" appearance.
• MRI (subacute/chronic): T2*/GRE/SWI sensitive for microhemorrhages; DWI for edema.

Management

• ICU monitoring: ICP, CPP, sedation, osmotherapy (mannitol/hypertonic saline).
• Seizure prophylaxis (levetiracetam 7d).
• Surgical evacuation if: mass effect, midline shift >5mm, GCS drop, refractory ICP.
• Decompressive craniectomy for malignant edema.

Outcomes

Depend on volume, location, age, GCS. Contusions may evolve to encephalomalacia, gliosis, post-traumatic epilepsy.

Contusion = structural brain injury; requires neurosurgical vigilance.