• Penetration by foreign object such as knife, bullet etc. or by fragments of skull in a depressed fracture. • By distortion of the skull. When a localised segment of the skull undergoes deformation, shear strains may develop in the brain tissue underlying the indentation, and a contusion may be produced in the surface layers of the brain tissue. If a fracture occurs , pieces of bone may penetrate the dura and lacerate the brain. • Due to movement of brain in relation to the skull Cerebral contusion • When a localised segment of the skull undergoes deformation at the moment of impact. Shear strains may develop in the brain tissue underlying the indentation, and a zone of contusion may be produced in the surface layers of the brain. • Most often they occur in cerebral and cerebellar cortices and subcortical areas. Post-traumatic CT scan of brain showing bilateral contusion of frontal cerebral region: Types: • Intermediary coup contusions: Contusions found in deeper structures of the brain along the line of impact.
• Fracture contusions : Contusions caused due to fracture of the
skull.
• Gliding contusions : Contusions in the cortex and white
matter of frontal and central convolutions.
• Herniation contusions : Contusions in the cerebellar tonsils
and the medulla oblongata. Cerebral laceration • They are traumatic lesions in the brain in which there is loss of continuity of the substance of the brain. • When the parenchyma is completely disorganised, it is termed as pulpefaction. • Lacerations are usually seen underneath skull fractures. • All penetrating injuries produce laceration of brain. • Laceration may also be produced without fracture of skull, when they are usually found in regions where the brain is in contact with projecting buttresses and ridges on the inner surface of the skull. Coup and Contrecoup lesions: • Coup injury(Blow impact): It means that the injury is located beneath the area of impact and results directly by the impacting force
• Contrecoup injury : It means that the lesion is present in an
area opposite to the side of impact. Contrecoup injuries are rare before the age of three. Mechanism: • Contrecoup injury is caused when the moving head is decelerated suddenly by hitting a firm surface, eg., striking the head on the ground during the fall, usually seen in traffic accidents ( deceleration injury). • Occipital injuries produce severe and extensive contrecoup lesions in the frontal region. The irregular bony prominences, especially of the orbital and cribriform plates, and the lesser wings of the sphenoid, contuse or lacerate the base of the frontal lobes and the tips of the temporal lobes. • A blow to the head produces a coup contusion, while contrecoup contusions are either small or absent. • A fall on the head produces contrecoup contusions, while coup contusions are small or absent. Concussion of the brain • Definition : concussion is a state of temporary unconsciousness (due to partial or complete paralysis of cerebral function), due to head injury, comes on immediately after injury, is always followed by amnesia, and tends to spontaneous recovery. • Mechanism : it occurs due to acceleration or deceleration of the head. Cerebral concussion may be produced by direct violence to the head, or by indirect violence as a result of violent fall upon the feet or buttocks, by an unexpected fall on the ground in traffic or industrial accidents. • Severe injuries occur in coronal head motion only. • Medicolegal importance – in case of head injury, if the patient becomes unconscious, in between he may become conscious, which again terminates into unconsciousness. These periods of consciousness are labelled as lucid interval.
• The person is responsible for acts done(civil or criminal) during lucid interval.
• ( The period of sanity in an insane person is also called lucid interval).
• Diffuse axonal injury (DAI) is a brain injury in which
extensive lesions in white matter tracts occur over a widespread area. DAI is the result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated, as may occur in car accidents, falls, and assaults.Vehicle accidents are the most frequent cause of DAI.
• Immediate disconnection of axons could be observed in severe brain
injury, but the major damage of DAI is delayed secondary axon disconnections slowly developed over an extended time course Punch-Drunk syndrome (traumatic encephalopathy/dementia pugilistica) • It refers to the chronic changes in the brain of a boxer, which usually manifest after many episodes of minor head injuries. • There will be deterioration in speed and coordination in boxers. In extreme cases, it is recognised by slurred speech, memory loss, stiff limbs and outbursts of violence. Punch-Drunk Syndrome. Cerebral oedema. • Cerebral oedema occurs due to a localised or diffuse abnormal accumulation of water and sodium, which increases the volume of the brain. • It is caused due to the increase in the intravascular pressure , increased permeability of the cerebral vessels, and decrease in plasma colloid osmotic pressure.
• Focal oedema is almost invariably associated with and
secondary to contusions and lacerations of the brain. Focal oedema in the brainstem is usually fatal. • Generalised cerebral oedema occurs with diffuse brain injury. THANK YOU.