Cranial Care

 Intracranial Hematomas
 Hydrocephalus
 Brain Tumors
 Skull Fractures
 Aneurysm
 Concussion
 Contusion
 Brain Abscess
 Brain Metastasis

Contusion

What is a Contusion?

When we hit our shin or arm on a table, a black and blue mark appears which we call a bruise.
A contusion in the brain is essentially the same thing, a bruise that forms when you hit your
head. A contusion is a focal injury (limited and localized) and consists of an area of
hemorrhage (bleeding), which can damage neurons and produce swelling within the brain. The
damage caused by the contusion depends on where the head is impacted and the direction of
the stress on the brain from the impact. Most often, contusions are the result of differential
movement between the skull and the brain itself. As the skull receives the initial impact, it
transfers the energy from the impact to the brain causing a contusion to form where the brain
collides against the rough surface of the skull. A contusion can result in coma and death. Fig.1
shows an area of subarachnoid hemorrhage with bleeding and an area of brain contusion
where the white ischemic brain has died.

Figure 1

Each area of the brain is responsible for a specific function of the human body. For example,
parts of the frontal lobe (located in the front of the brain) are responsible for the ability to think
and the ability to plan ahead. Other parts within the frontal lobe are devoted to motor
capabilities; like the ability to move our eyes or head, orient our bodies and minds to what is
going on around us, and move the opposite arm and leg. Brain damage (a contusion) results
from the destruction of neurons. Neurons act as a communications network for the human
nervous system. The extent of the damage, as well as the effects of that damage, are
dependent on the area of the brain which is injured. If the injury impacts the frontal lobe you are
likely to have impaired thought processes or paralysis of the opposite side of the body. The
Occipital lobe, on the other hand, is located in the back of the head and is responsible for all
aspects of our visual capabilities. So, if a contusion were to form in the Occipital lobe, it would
be probable that the victim could loose a half of their vision field in each eye.

A contusion is a permanent injury. The effects of the injury are dependent upon where the
contusion forms. If a contusion forms in a critical area needed to perform a specific function of
the brain, such as a direct hit to the brain’s motor area, the injury wipes out any hope of
recovering that function, in this case leaving the victim with permanent paralysis. There is also
a chance that the contusion will not cause any alteration in the person’s ability to function
normally, if it forms in an area of the brain that is not critical, or what is called a silent area.

The third possibility is if the contusion forms in an overlapping area of the brain. An overlapping
area of the brain is one that is used to perform parts of more than one function. Because only
part, of the area needed to perform that function is gone, it is possible to re-learn the ability that
was lost in the injury by re-routing the signals to areas of the brain not affected by the
contusion. This means that although brain function is impaired, the patient may recover.

What are the symptoms of a contusion?

Symptoms depend on the extent of the brain contusion. A small contusion may not produce
any visible symptoms if the damaged areas are not critical. The involvement of functional areas
of the brain will produce varying degrees of impairment in:

 Thinking
 Reading and Writing
 Speech
 Memory
 Vision
 Coordination

If you experience a head injury it is always a good idea to have it looked at by a physician. It is
also important to pay close attention to any changes or irregularities in your physical or mental
capabilities after the incident and if they persist for any length of time to consult a physician.
For example, if your vision is impaired, or you are having trouble manipulating a part of your
body, like a leg or arm. Or if your speech is slowed, or thought process is cloudy.

Treatment

Treatment focuses on:

 Steroids which stabilize enzyme systems.

 Mechanical respirators and osmotic drugs that attempt to control swelling of the brain.
 Anti-convulsants to prevent seizure.
 Control of blood pressure to avoid worsening brain swelling.
 General fluid and nutritional support.
 Surgical procedure to control brain swelling by draining spinal fluid and removing
 hemorrhagic areas of the brain that aggravate brain swelling.

With time and luck the brain contusion can heal. At that time rehabilitation is started. The
specific program depends on the area damaged. For example, speech therapy for impaired
speech, cognitive-retraining of the brain for higher mental function losses, and physical therapy
for motor paralysis.

The permanent residual of a brain contusion depends on the areas damaged, the severity of
the damage and the size of the injured area.

The Recovery Process is often a slow, frustrating process of re-learning a previously simple
activity performed by the victim on a daily basis. Support from family and friends can be crucial
to the success of treatment.