eMedicine Specialties > Radiology > Brain/Spine

Brain, Contusion: Multimedia

Author: Denise Morales, MD, Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of MI
Coauthor(s): Orlando Diaz-Daza, MD, Assistant Professor, Department of Radiology, Ben Taub General Hospital, Baylor College of Medicine; Roman Hlatky, MD, Assistant Professor, Center for Neurosurgical Sciences, The University of Texas Health Science Center; L Anne Hayman, MD, Director of Herbert J Frensley Center for Imaging Research, Professor, Departments of Radiology, Psychiatry, and Behavioral Sciences, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Apr 3, 2007

Multimedia

Schematic diagrams of contusion locations in sagi...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.
Schematic diagrams of contusion locations in sagi...

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.

Acute brain contusion. Axial CT scan obtained in ...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).
Acute brain contusion. Axial CT scan obtained in ...

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).

Enlargement of an acute brain contusion. (A) Axia...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.
Enlargement of an acute brain contusion. (A) Axia...

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.

Evolution of an acute brain contusion. (A) Axial ...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).
Evolution of an acute brain contusion. (A) Axial ...

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).

Resolution of a brain contusion. (A) Axial CT sca...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).
Resolution of a brain contusion. (A) Axial CT sca...

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).

Acute gliding brain contusions. Axial CT scan obt...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).
Acute gliding brain contusions. Axial CT scan obt...

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).

Comparison of a CT scan with a xenon blood-flow r...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.
Comparison of a CT scan with a xenon blood-flow r...

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.

Comparison of a CT scan and MRIs showing acute co...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).
Comparison of a CT scan and MRIs showing acute co...

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).

MRI in a 2-day-old brain contusion. (A) T1-weight...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).
MRI in a 2-day-old brain contusion. (A) T1-weight...

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).

Comparison of a CT scan and MRIs obtained 1 day a...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.
Comparison of a CT scan and MRIs obtained 1 day a...

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.

Comparison of a CT scan and MRIs obtained 4 hours...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).
Comparison of a CT scan and MRIs obtained 4 hours...

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).

More on Brain, Contusion

Overview: Brain, Contusion
Imaging: Brain, Contusion
Follow-up: Brain, Contusion
Multimedia: Brain, Contusion
References

References

  1. Kraus JF, Black MA, Hessol N, et al. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol. Feb 1984;119(2):186-201. [Medline].

  2. Giles GM, Clark-Wilson J. Brain Injury Rehabilitation: A Neurofunctional Approach. San Diego, CA: Singular Publishing Group; 1993.

  3. NIH. Rehabilitation of persons with traumatic brain injury. NIH Consensus Statement. Oct 26-28 1998;16(1):1-41. [Medline].

  4. Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj. Jan 1996;10(1):47-54. [Medline].

  5. Thurman DJ, Alverson C, Dunn KA, et al. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil. Dec 1999;14(6):602-15. [Medline].

  6. Annegers JF, Grabow JD, Kurland LT, Laws ER Jr. The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974. Neurology. Sep 1980;30(9):912-9. [Medline].

  7. Woo B. The Rehabilitation of People with Traumatic Brain Injury. Malden, MA:. Blackwell Science;2000.

  8. Fife D. Head injury with and without hospital admission: comparisons of incidence and short-term disability. Am J Public Health. Jul 1987;77(7):810-2. [Medline].

  9. Zimmerman RA, Gibby WA, Carmody RF. Head and brain trauma. In: Neuroimaging: Clinical and Physical Principles. New York:. Springer-Verlag;2001: 699-729.

  10. Umile EM, Plotkin RC, Sandel ME. Functional assessment of mild traumatic brain injury using SPECT and neuropsychological testing. Brain Inj. Jul 1998;12(7):577-94. [Medline].

  11. Kant R, Smith-Seemiller L, Isaac G, Duffy J. Tc-HMPAO SPECT in persistent post-concussion syndrome after mild head injury: comparison with MRI/CT. Brain Inj. Feb 1997;11(2):115-24. [Medline].

  12. Laatsch L, Pavel D, Jobe T, et al. Incorporation of SPECT imaging in a longitudinal cognitive rehabilitation therapy programme. Brain Inj. Aug 1999;13(8):555-70. [Medline].

  13. Bigler ED. Neuroimaging in pediatric traumatic head injury: diagnostic considerations and relationships to neurobehavioral outcome. J Head Trauma Rehabil. Aug 1999;14(4):406-23. [Medline].

  14. Collins JG. Types of injuries by selected characteristics. Vital Health Stat 10. Dec 1990;(175):1-68. [Medline].

  15. Fife D, Faich G, Hollinshead W, Boynton W. Incidence and outcome of hospital-treated head injury in Rhode Island. Am J Public Health. Jul 1986;76(7):773-8. [Medline].

  16. Frankowski RF. The demography of head injury in the US. In: Miner M, Wagner KA, eds. Neurotrauma. Vol 1. Boston:. Butterworths;1986:1-17.

  17. Gean AD. Imaging of Head Trauma. New York: Raven Press Ltd;1994.

  18. Grossman RI, Yousem DM. Head trauma. In: Neuroradiology: The Requisites. St. Louis, Mo:. Mosby-Year Book;1994:156-7.

  19. Kraus JF, McArthur DL. Incidence and prevalence of, and costs associated with, traumatic brain injury. In: Rehabilitation of the Adult and Child with TBI. 3rd ed. Philadelphia: FA Davis; 1999.

  20. Kraus JF, Sorenson SB. Epidemiology. In: Silver JM, Yudofsky SC, Hales RE, eds. Neuropsychiatry of TBI. Washington, DC:. American Psychiatric Press;1994: 3-41.

  21. Orrison WW Jr, Moore KR. Neuroimaging & head trauma. In: Neuroimaging. Philadelphia, Pa:. WB Saunders Co;2000: 901-2.

  22. Osborne AG. Craniocerebral trauma. In: Diagnostic Neuroradiology. St. Louis, Mo:. Mosby-Year Book;1994:217.

  23. Rose FD, Johnson DA. Brain Injury and After: Towards Improved Outcome. West Sussex, England:. John Wiley & Sons;1996.

  24. Rosenthal M, Griffith E, Kreutzer J, et al. Rehabilitation of the adult and child with traumatic brain injury. 3rd ed. Philadelphia:. FA Davis;1999: 8-9.

  25. Sganzerla EP, Tomei G, Rampini P. A peculiar intracerebral hemorrhage: the gliding contusion, its relationship to diffuse brain damage. Neurosurg Rev. 1989;12 Suppl 1:215-8. [Medline].

  26. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. Jul 13 1974;2(7872):81-4. [Medline].

  27. Whitman S, Coonley-Hoganson R, Desai BT. Comparative head trauma experiences in two socioeconomically different Chicago-area communities: a population study. Am J Epidemiol. Apr 1984;119(4):570-80. [Medline].

Further Reading

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

Contributor Information and Disclosures

Author

Denise Morales, MD, Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of MI
Denise Morales, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Orlando Diaz-Daza, MD, Assistant Professor, Department of Radiology, Ben Taub General Hospital, Baylor College of Medicine
Orlando Diaz-Daza, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Roman Hlatky, MD, Assistant Professor, Center for Neurosurgical Sciences, The University of Texas Health Science Center
Roman Hlatky, MD is a member of the following medical societies: Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

L Anne Hayman, MD, Director of Herbert J Frensley Center for Imaging Research, Professor, Departments of Radiology, Psychiatry, and Behavioral Sciences, Baylor College of Medicine
L Anne Hayman, MD is a member of the following medical societies: American Heart Association, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Chi-Shing Zee, MD, Chief of Neuroradiology, Professor, Departments of Radiology and Neurosurgery, University of Southern California School of Medicine
Chi-Shing Zee, MD is a member of the following medical societies: American Society of Neuroradiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Robert L DeLaPaz, MD, Director, Professor, Department of Radiology, Division of Neuroradiology, Columbia University
Robert L DeLaPaz, MD is a member of the following medical societies: American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.