(b) Contrecoup contusion. This contusion occurs in areas of the brain
that are remote from the focus of impact.
1 Blows to the back of the head commonly cause this type of
contusion. A contrecoup contusion can, however, be caused by a blow to any part of
2 There is scientific disagreement on exactly how a contrecoup
contusion occurs. One theory is that the impact of something on the skull accelerates
or decelerates the brain within the cranial cavity. The result is that the brain collides
with the inner surface of the skull and becomes bruised.
Treatment. Patients with cerebral contusion require hospitalization for
e. Intracranial Hematoma. Intracranial hematoma (within the cranium, a
swelling that contains blood) is a rare injury, but important because this injury is the
most common cause of preventable death following a head injury. Two classifications
of traumatic intracranial hematomas are acute epidural hematomas and acute subdural
(1) Acute epidural hematoma. This type of hematoma is an accumulation of
blood between the dura (the thick, dense, fibrous layer which covers and protects the
brain and the spinal cord) and the inner surface of the skull. The cause of an acute
epidural hematoma is either a tear in a meningeal artery within the dura or an impact
injury to a dural venous sinus. Since the bleeding is arterial, pressure builds rapidly and
death can occur quickly. But, the prognosis for recovery is good if the patient is
diagnosed correctly and treated early. Signs and symptoms of acute epidural
hematoma include the following:
(a) A history of head trauma.
(b) Initial loss of consciousness.
Next, a period of consciousness and coherence.
(d) Patient lapses back into unconsciousness.
(e) Patient develops paralysis on the opposite side of the injury with
dilated/fixed pupils of the eye on the same side as the injury.
If not treated, paralysis is followed by death.