Multimedia
 | Media file 1: Schematic diagrams of contusion locations in sagittal midline (A), lateral (B), and base (C) views show the areas most commonly affected by contusions (red) and those that are occasionally affected by contusions (blue). Areas that are predominantly affected by contusions include the orbitofrontal cortex, anterior temporal lobe, and posterior portion of the superior temporal gyrus area, with the adjacent parietal opercular area. Areas that are less commonly affected include the lateral midbrain, inferior cerebellum and adjacent tonsil, and the midline superior cerebral cortex. |
 | Media file 2: Acute brain contusion. Axial CT scan obtained in a patient immediately after a high-speed motor vehicle accident demonstrates a large, right frontal contusion with hemorrhage and surrounding edema. A smaller, subtle, right temporal cortical contusion (short arrow) is noted, as well as a small, left frontal subdural hematoma (long arrow). |
 | Media file 3: Enlargement of an acute brain contusion. (A) Axial CT scan obtained on day 1 after head trauma shows a subtle area of slightly hypoattenuating right frontal lobe contusion (arrows) with a small, overlying, right frontal subdural hematoma. Note that the scalp hematomas in the frontal and temporal regions indicate areas of direct force. (B) Companion axial CT scan obtained on day 2 shows a large, right frontal contusion (arrow) and a new, large, left temporal contusion (arrow). Note that the scalp hematomas have increased in size. |
 | Media file 4: Evolution of an acute brain contusion. (A) Axial CT scan obtained immediately following severe blunt trauma to the head shows a small, left frontal epidural hematoma (arrow). Extensive subgaleal bicranial hematomas are seen. (B) Companion CT scan obtained 6 days after trauma shows the small, left frontal epidural hematoma (long arrow) and smaller areas of subgaleal bicranial hematomas. Note that the previously isoattenuating contusion in the right posterior temporal area is now evident (short arrows in B). |
 | Media file 5: Resolution of a brain contusion. (A) Axial CT scan obtained on day 1 after a high-speed motor vehicle accident shows subtle evidence of bifrontal hemorrhagic contusions (arrows). (B) Axial CT scan obtained on day 2 shows increased hemorrhage within the inferior frontal cortex bilaterally (arrows). (C) Axial CT scan obtained on day 14 shows resolution of the bright blood (upper arrows) and residual areas of dark edema in both frontal lobes and a subtle area throughout the right temporal lobe (lower arrows). |
 | Media file 6: Acute gliding brain contusions. Axial CT scan obtained immediately after blunt trauma to the left convexity of the skull resulted in severe swelling of the entire left cerebral hemisphere with loss of the gyral pattern secondary to edema. A small collection of subarachnoid blood is present (up arrow). The right hemisphere shows contrecoup gliding contusions (down arrows). |
 | Media file 7: Comparison of a CT scan with a xenon blood-flow radionuclide scan. (A) CT scan shows bifrontal contusions following severe head trauma (arrows). (B) Companion CT scan showing xenon uptake demonstrates dark regions (arrows), indicating decreased perfusion in the contused brain. |
 | Media file 8: Comparison of a CT scan and MRIs showing acute contusions. (A) Contrast-enhanced axial CT scan obtained immediately after head trauma shows a foreign body in the scalp (arrow) that marks the site of direct impact. Blood is noted in the right lateral ventricle. Chronic white-matter changes are present. (B) Axial T1-weighted MRI obtained on the same day shows the scalp changes at the site of the trauma (arrow). There is minimal underlying superficial cortical hyperdensity consistent with cortical contusion. (C) Comparison gadolinium-enhanced T1-weighted MRI shows minimal enhancement of the left posterior temporal-occipital cortex below the site of the scalp trauma (arrow). (D) Companion fluid-attenuated inversion recovery (FLAIR) MRI shows the extent of the left cortical contusion (arrow). Note the hyperintense signal from blood in cerebrospinal fluid and the displaced right lateral ventricle with surrounding signal intensity changes in the adjacent optic radiations (arrow). |
 | Media file 9: MRI in a 2-day-old brain contusion. (A) T1-weighted image shows obliteration of the left temporal horn due to subdural hemorrhage (arrows). (B) T2-weighted and (C) fluid-attenuated inversion recovery (FLAIR) images show hyperintense signal surrounding isointense blood in the left temporal lobe. The FLAIR image shows the left anterior temporal subdural hemorrhage and a posterior extension more clearly (arrow). (D) Diffusion-weighted MRI shows areas of restricted diffusion in the left temporal lobes and 2, small, abnormal areas in the right midbrain (arrows). The bilateral anterior frontal and temporal hyperintense areas represent artifacts (arrows). |
 | Media file 10: Comparison of a CT scan and MRIs obtained 1 day after acute trauma. (A) Acute CT scan shows a large, temporal-lobe contusion lateral to the displaced left temporal horn (arrows). (B) T1-weighted MRI shows hypointense signal in the left temporal lobe, with mass effect causing a clear loss of sulcal pattern (arrows). (C) Spin-density MRI shows mixed signals within the contusion with predominant isointensity. Note partial volume artifacts surrounding the brainstem.(D) Spin-echo T2-weighted MRI shows mixed intensity throughout the large left temporal contusion. (E) Fluid-attenuated inversion recovery (FLAIR) MRI demonstrates petechial hemorrhages that are isointense to the brain. Note the accompanying abnormally bright signal in the left optic radiations (arrows); one of many small shearing injuries is seen at the right occipital cortex/gray matter junction (arrow). (F) Diffusion-weighted MRI shows mixed signals with restricted diffusion in the most posterior aspect of the large left temporal contusion. An artifact appears in the right temporal lobe. |
 | Media file 11: Comparison of a CT scan and MRIs obtained 4 hours after acute trauma. (A) CT scan shows focal contusion in the left superior temporal gyrus (arrow) and a posterior falx subdural hematoma (arrows). Incidental white matter changes are present in both hemispheres. Incidental left parietal bone postsurgical changes are present. (B) T1-weighted MRI shows slight hypointensity in the contusion (arrows) and isointense signal in the subdural (arrows). Incidentally noted in the anterior corpus callosum is a small, hypointense scar from a prior intraventricular shunt (white arrow). Postsurgical changes in the left parietal bone are depicted. (C) Spin-density MRI shows a large area of hyperintense signal at the contusion site (arrows) and hyperintensity in the subdural blood (arrows).(D) T2-weighted MRI shows hyperintense edema surrounding the hemorrhagic area, which has a hypointense ring (arrow) and an isointense center. The subdural blood is inconspicuous on this image. Chronic white-matter signal abnormalities match those seen on the CT scan (A). (E) Gradient-echo MRI shows marked hypointense signal in the falcine subdural hematoma (arrows), contusion (arrow), and right frontal region, representing magnetic susceptibility products due to subacute hemorrhage. (F) Diffusion-weighted MRI shows restricted diffusion in a zone surrounding the contusion (arrows). Artifacts are depicted in the cortex of both hemispheres (red and yellow arrows). |
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Further Reading
Related eMedicine topics
Classification and Complications of Traumatic Brain Injury
Hypoxic-Ischemic Brain Injury in the Newborn
Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology
Clinical guidelines
Assessment: Glasgow Coma Scale score. In: Guidelines for the prehospital management of severe traumatic brain injury, second edition.
ACR Appropriateness Criteria® head trauma.
Keywords
brain injury, acute traumatic CNS damage, central nervous system injury, head trauma, head injury, skull injury, skull fracture, facial injury, facial soft tissue injury, cranial soft tissue injury, cranial fracture, concussion, brain hemorrhage, cranial contusion, laceration of the brain, punctate parenchymal hemorrhage, microhemorrhage, traumatic brain injury, TBI, coup contusion, contrecoup contusion, brain contusion, scalp hematoma
