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Cerebral Contusion and Intracerebral Hematoma

A contusion is a type of traumatic brain injury (TBI) that causes bruising of the brain tissue; a hematoma is heavy bleeding into or around the brain. The severity of a TBI can range from a mild concussion to the extremes of coma or even death.

Each year, minor incidents of TBI happen to over one million people in the United States. These minor injuries result in the treatment and release from hospital emergency departments. Another 230,000 people are hospitalized each year with TBI. Of these people, 99,000 will show a lasting disability.

Causes

A contusion may result when a sudden physical assault on the head causes damage to the brain. The most common cause of TBI is motor vehicle accidents, accounting for almost half of all TBIs that require hospitalization. Sports or physical activity is the second most common cause, and assaults are third. For those who are over age 65, falls are the number one cause. It can also occur in response to shaking of the brain within the confines of the skull, an injury called "countrecoup." Shaken baby syndrome is a severe form of head injury that occurs when a baby is shaken forcibly enough to cause extreme countrecoup injury.

Damage to a major blood vessel within the head can cause a hematoma, or heavy bleeding into or around the brain.

Symptoms

Any type of TBI, no matter how minor it may appear should be taken seriously. If you experience any loss of consciousness, no matter how brief, a doctor should be seen as soon as possible. Even if unconsciousness does not occur, the several hours that follow are still very important and you should watch for the following symptoms:

  • Headache
  • Nausea, vomiting
  • Slurred speech
  • Restlessness
  • Increased drowsiness
  • Change in pupils
  • Confusion about the time or date
  • Memory loss
  • Change in personality
  • Depression
  • Irritability
  • Other emotional and behavioral problems
  • Some people may have seizures as a result of a TBI.

If any of these symptoms occur, a doctor should be seen immediately, for they could mean that the brain is bleeding or swelling.

Diagnosis

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

In addition to a physical examination, the physician may order an MRI or CT-scan of the head to detect any bleeding, brain damage or skull fractures in patients with head injuries. Imaging studies are the key component in the diagnosis of cerebral contusion and intracerebral hematoma.

Prognosis

The outcome of TBI depends on the cause of the injury and on the location, severity, and extent of neurological damage: outcomes range from good recovery to death. Doctors often use the Glasgow Coma Scale to rate the extent of injury and chances of recovery. The scale (3-15) involves testing for three patient responses: eye opening, best verbal response, and best motor response. A high score indicates a good prognosis and a low score indicates a poor prognosis.

Treatment

Immediate treatment for TBI varies according to the type and severity of the injury and involves:

  • Surgery to control bleeding in and around the brain
  • Monitoring and controlling intracranial pressure
  • Insuring adequate blood flow to the brain, and
  • Treating the body for other injuries and infection

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