A hemorrhagic contusion is a type of traumatic brain injury (TBI) that involves bruising and localized bleeding within the brain tissue. Unlike a concussion, which is a temporary disturbance of brain function, a contusion involves physical damage that is visible on medical imaging. The severity of a hemorrhagic contusion can range from small bruises with minimal impact to large areas of bleeding that cause substantial neurological problems.
Causes of a Hemorrhagic Contusion
Hemorrhagic contusions result from a direct and forceful impact to the head. Common scenarios include motor vehicle accidents, significant falls, sports-related incidents, and physical assaults. These events cause the brain to undergo rapid acceleration and deceleration within the skull, leading to bruising.
A frequent mechanism is a coup-contrecoup injury. This occurs when the force of an impact causes the brain to strike the inside of the skull at the point of the blow (the “coup” injury). The brain then rebounds, hitting the opposite side of the skull and causing a second injury, known as the “contrecoup” lesion.
These injuries are particularly common in the frontal and temporal lobes of the brain. The irregular surfaces of the skull base in these areas can accentuate the damage as the brain tissue moves across them during an impact.
Associated Symptoms
The signs of a hemorrhagic contusion vary depending on the size and location of the bruise. Some individuals may experience symptoms immediately after the injury, while for others, they may develop gradually over several hours or days.
Common symptoms can include:
- A persistent headache
- Confusion or dizziness
- Nausea or vomiting
- Unusual sleepiness or loss of consciousness
- Seizures
- Weakness or paralysis in a specific limb
- Difficulties with speech and language
Dilation of one pupil can indicate increasing pressure on the brain. Because symptoms can evolve, any head injury followed by these signs warrants immediate medical attention to assess the extent of the damage.
Diagnostic Process
Confirming a diagnosis of a hemorrhagic contusion begins with a neurological examination. A physician will assess a patient’s level of consciousness, reflexes, muscle strength, and cognitive functions like memory and concentration. This evaluation helps determine the severity of the injury and guides the next steps.
Medical imaging is the definitive method for identifying a hemorrhagic contusion. A computed tomography (CT) scan is the first imaging test performed in an emergency setting. CT scans are highly effective at detecting fresh bleeding, making them ideal for acute trauma.
A magnetic resonance imaging (MRI) scan may be used to provide a more detailed view of the brain. While a CT scan is faster, an MRI is more sensitive in detecting smaller contusions and assessing damage to the brain’s soft tissues. An MRI might be ordered if symptoms worsen or to get a clearer picture of the injury.
Medical Management and Treatment
The treatment for a hemorrhagic contusion is tailored to the severity of the injury and the patient’s symptoms. For individuals with small contusions and mild symptoms, management involves close observation in a hospital. This allows healthcare providers to monitor for any signs of neurological deterioration.
A primary concern is controlling intracranial pressure (ICP), which is the pressure inside the skull. Elevated ICP can lead to further brain damage and is treated with medications like mannitol or hypertonic saline to reduce swelling. Keeping the head of the bed elevated also helps lower this pressure.
In severe cases where a large blood clot, or hematoma, forms and exerts pressure on the brain, surgery may be necessary. A craniotomy can be performed to remove the hematoma and relieve the pressure. Anticonvulsant medications may also be prescribed to prevent seizures. The goal of treatment is to stabilize the patient and prevent secondary brain injury.