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PubMed1990

Cardiac contusion in pediatric patients with blunt thoracic trauma.

To investigate the prevalence of myocardial contusion associated with blunt chest trauma in the pediatric age group, all patients admitted to our institution during a 6-month period with blunt thoracic trauma severe enough to produce a pulmonary contusion or rib fracture were prospectively evaluated. Cardiac evaluation was undertaken, including a multiple-gated acquisition (MUGA) cardiac scan, serial electrocardiograms (ECG), and serum creatine phosphokinase (CPK) and CPK isoenzymes. Seven patients, ranging in age from 2 1/2 to 18 years, with rib fractures or pulmonary contusion by chest roentgenograph were identified. One patient was injured as a passenger in a motor vehicle accident, five were struck by automobiles as pedestrians, and one sustained traumatic asphyxia when a car, supported by a jack, fell on his chest. All had at least one other major organ system injured. All patients had pulmonary contusions as determined by chest radiograph, and two had associated rib fractures. In 43% (three of seven) of patients, a significant cardiac contusion was identified, defined by abnormal right or left ventricular wall motion and a decreased ejection fraction on MUGA scan, and confirmed by an increase in cardiac enzymes and isoenzymes. However, in contrast with adults, no patients had ECG abnormalities. This limited series suggests that cardiac contusion may occur frequently in pediatric patients who have suffered from blunt thoracic trauma significant enough to result in pulmonary contusion. An MUGA scan provides a rapid, noninvasive assessment of cardiac damage in this setting. Further studies will be required to determine the clinical significance and long-term consequences of traumatic myocardial damage in the pediatric population.

Accidents, Traffic↗
PubMed1997

Subpleural sparing: a CT finding of lung contusion in children.

PURPOSE: To evaluate the presence of subpleural sparing as an aid in differentiation of contusion from other causes of lung opacification in children. MATERIALS AND METHODS: In 29 children, the computed tomographic (CT) features of 40 lung contusions were reviewed for the presence of subpleural sparing. Other CT characteristics of lung contusion such as location, shape, and confluence were also evaluated. The presence of subpleural sparing was also evaluated in cases of atelectasis, pulmonary laceration, and a control group of CT scans obtained in 45 patients with bacterial pneumonia and no history of trauma. RESULTS: Subpleural sparing was seen at CT in 38 (95%) of the lung contusions and none of the cases of atelectasis, laceration, or pneumonia (P = .0001). Lung contusions tended to be posterior (60%), crescentic (50%), or amorphous (45%) and have confluent and nodular components (70%). CONCLUSION: The presence of subpleural sparing on CT scans enables accurate identification of lung contusion and differentiation of contusion from other causes of lung opacification in children after trauma.

Case-Control Studies↗
PubMed1979

Pathophysiology of pulmonary contusion in dogs.

We produced a localized right lower lobe (RLL) contusion in 14 anesthetized ventilated dogs, 7 of which were treated with positive end-expiratory pressure (PEEP group). We measured gas exchange, pulmonary mechanics, and regional function before and 5 h after the contusion. Arterial PO2 decreased by 20 Torr and venous admixture doubled in both groups during air breathing. The shunt fraction (Qs/Qt) was minimally increased, despite a large lobar Qs/Qt (0.43) in the contused RLL. These results were explained by reduced ventilation per unit volume (VA/V), and ventilation-to-perfusion ratios of the contused RLL measured with 133Xe technique. We conclude that pulmonary contusion causes a leak of blood and plasma, flooding 25% of the air spaces of the RLL at FRC, reducing the compliance of adjacent air spaces, and resulting in a reduced VA/V and a large RLL Qs/Qt. These results are consistent with the observed reduction in regional volume and perfusion in the contused RLL, and suggest that Qs/Qt was not increased because blood flow was markedly reduced to flooded air spaces. PEEP reduced the hypoxemia, but increased the contusion.

Animals↗
PubMed1996

MR diagnosis of bone contusions of the knee: comparison of coronal T2-weighted fast spin-echo with fat saturation and fast spin-echo STIR images with conventional STIR images.

OBJECTIVES: Bone contusions consist of posttraumatic marrow change resulting from a combination of hemorrhage, edema, and microtrabecular injury and are depicted on MR images as geographic, nonlinear areas of abnormally increased T2 marrow signal intensity. Detection of bone contusions is important, not only in that they are frequently a sign of more serious associated injury, but in that isolated contusions may account for clinical symptoms and thereby obviate further workup. We evaluated two promising rapid imaging sequences, T2-weighted fast spin-echo with fat saturation and fast spin-echo short inversion time (T1) inversion recovery (STIR) and compared their efficacy to that of conventional STIR for the diagnosis of bone contusions in knees. SUBJECTS AND METHODS: Fifty-one consecutive military, retired military, and military-dependent patients were prospectively entered. Imaging consisted of three experimental sequences: coronal T2-weighted fast spin-echo with spectroscopic fat saturation, fast spin-echo STIR, and STIR, as well as conventional T1, proton density, and T2. Each examination was interpreted by three radiologists, for a total of 153 interpretations. Each interpretation consisted of the conventional sequences plus one of the three experimental sequences, blinded to the other two, specifically addressing menisci, ligaments, bones, and soft tissues. A positive test result was defined as a diagnosis of bone contusion on any one of the three independent interpretations of a given examination. Our gold standard was the consensus opinion of all three radiologists in a retrospective, unblinded evaluation of all imaging sequences. Sensitivity and specificity of fast spin-echo with fat saturation and fast spin-echo STIR were then calculated and compared with STIR. RESULTS: Sensitivity and specificity for bone contusion diagnosis in the three experimental sequences were as follows: fast spin-echo with fat saturation, 91% sensitivity and 86% specificity; fast spin-echo STIR, 96% sensitivity and 96% specificity; and conventional STIR, 83% sensitivity and 93% specificity. Our results showed no statistically significant difference between either of the fast spin-echo sequences and conventional STIR (p > .05). CONCLUSION: Because of their comparable accuracy and short imaging time characteristics, coronal fast spin-echo with fat saturation and fast spin-echo STIR sequences are superior to conventional STIR sequences for the diagnosis of bone contusions in knees.

Adolescent↗
PubMed1998

[Magnetic resonance in the identification and assessment of extent and severity of bone contusion damage: comparison of several types of imaging (SE/T1, GE/T2 and SE/T1) with fat suppression].

INTRODUCTION: Bone marrow contusion is a common cause of chronic joint pain in the post-traumatic knee; it is usually associated with meniscal and/or ligament damage but it may also be the only abnormal sign. In this condition MRI plays a fundamental role because it is the only imaging technique which can diagnose it and accurately assess its extent and any cortical bone and/or cartilage involvement. We investigated the diagnostic potentials of 3 MR sequences in identifying and assessing the extent of bone contusion. MATERIAL AND METHODS: January, 1994, to December, 1997, we performed 539 MR examinations of the knee on 478 patients with chronic joint pain following trauma. We used T1-weighted SE, T2*-weighted GE and T1-weighted SE sequences with fat saturation (fs), paying great attention to technical parameter setting. The images were retrospectively reviewed by groups of radiologists using 2 semi-objective evaluation systems: a qualitative assessment to grade the ease of detection of the contusion with each sequence and a quantitative assessment of contusion extent and of osteochondral involvement, if any, again for each sequence. RESULTS: The qualitative analysis showed that GE and SE-fs sequences were superior to the conventional ones in identifying bone contusion foci; GE sequences tended to overestimate the number of poorly depictable lesions relative to SE-fs ones. The quantitative analysis showed that the conventional sequences tend to underestimate the foci extent, while GE and SE-fs sequences performed nearly the same in the assessment of high-grade lesions. The number of low-midgrade lesions was overestimated by GE sequences relative to SE-fs ones. DISCUSSION AND CONCLUSIONS: GE and SE-fs sequences permit accurate studies of bone contusions. Diagnostic efficacy is increased by enhancing the signal from non-fatty structures within a tissue rich in fat: the quantitative reduction of the non-fatty structural component and/or its replacement with abnormal components is thus best shown. Fat-suppression sequences were more accurate in defining lesion size, which is also related to low susceptibility to the artifacts from extrinsic and especially intrinsic structural inhomogeneities. In contrast, GE sequences demonstrated high susceptibility, which caused poorer definition of the contusion borders and, consequently, overestimation of the lesion size.

Adipose Tissue↗
PubMed2000

Evaluation of bone contusions with fat-saturated fast spin-echo proton-density magnetic resonance imaging.

OBJECTIVE: To evaluate the efficacy of fast spin-echo proton-density magnetic resonance imaging (MRI) with fat saturation sequences in the evaluation of bone contusions at the knee. METHODS: Analysis of 46 consecutive knee MRI examinations performed on patients referred from a sports medicine clinic after knee trauma. All examinations included coronal fast spin-echo proton-density fat saturation, fast spin-echo proton-density and fast spin-echo T2-weighted sequences. All 3 coronal sequences were blindly reviewed independently of each other by 3 experienced musculoskeletal radiologists to identify and grade bone contusions. RESULTS: Thirty-five bone contusions were identified in 24 patients. All bone contusions were identified on fast spin-echo proton-density fat saturation sequences, which was significantly greater than the percentage identified on either fast spin-echo T2-weighted sequences (21/35, 60%, p < 0.001) or fast spin-echo proton-density sequences (10/35, 29%, p < 0.001). Fourteen (40%) of the contusions were identified only on the fast spin-echo proton-density fat saturation sequences. The average grade of contusion for all 35 examinations was also significantly higher on the fast spin-echo proton-density fat saturation sequences than on the fast spin-echo proton-density and fast spin-echo T2-weighted sequences (p < 0.05). CONCLUSION: Fast spin-echo proton-density fat saturation sequences are more sensitive in the detection of bone contusions than fast spin-echo proton-density and fast spin-echo T2-weighted sequences. Assessment of other structures in the knee with fast spin-echo proton-density fat saturation MRI provides good spatial resolution and adequate T2-weighted information. It may have advantages over the more heavily T2-weighted fast spin-echo T2 fat saturation and inversion recovery sequences.

Adult↗
PubMed1989

Myocardial contusion in the stable patient: what level of care is appropriate?

To evaluate the significance of myocardial contusion, we evaluated 243 stable patients hospitalized for blunt chest trauma between 1982 and 1986. The groups were identified according to results of radionuclide angiography, mean injury severity score (ISS), and outcome. Group I (n = 71; mean ISS = 12.7) patients were those without myocardial contusion by radionuclide angiography. Two patients with cardiac complications were in this group. The patients with myocardial contusion were divided into two groups. Group II (n = 69; ISS = 19.5) patients had myocardial contusion as an isolated injury, and group III (n = 103; ISS = 30.9) patients had myocardial contusion and injury to at least one other organ system. Three patients from group II had cardiac complications. Eleven patients from group III had cardiac complications. There were no significant differences between the cardiac complication rate in the three groups, and each complication was present when the patient arrived in the emergency department. The predicted mortality rate based on ISS was 10% to 20% for patients with myocardial contusion, whereas the observed mortality rate for the groups (II and III) overall was 0.58%. We conclude that in the stable trauma patient myocardial contusion (1) does not by itself increase the risk of complication, (2) does not necessitate intensive care unit monitoring, (3) should be devalued when computing ISS scores, (4) may account for lengthy and often unnecessary hospitalization, and (5) in patients at risk for complications may be identified by ECG abnormalities on arrival to the emergency department.

Adolescent↗
PubMed1996

[Treatment outcome of surgical thoracic wall stabilization of the unstable thorax with and without lung contusion].

Between 1988 and 1994, 295 patients with blunt chest trauma were treated. Forty-two patients had flail chest, requiring mechanical ventilation. Open reduction and osteosynthesis (ASIF reconstruction plates or isoelastic rip clamps) of the chest wall were performed in 20 patients. For the purpose of analysis we separated the patients into five groups: group I (n = 10) had chest wall stabilization in flail chest without pulmonary contusion (average ISS 31.0, AIS-thorax 4.1); group II (n = 10) had chest wall stabilization in flail chest with pulmonary contusion (average ISS 37.0, AIS-thorax 4.3); group III (n = 18) had fail chest without pulmonary contusion (average ISS 36.3, AIS-thorax 4.2); group IV (n = 4) had flail chest with pulmonary contusion (average ISS 37.8, AIS-thorax 4.0); group V (n = 29) had pulmonary contusion without flail chest (average ISS 34.5. AIS-thorax 4.1). With open reduction and internal fixation of unstable chest wall segments, the duration of ventilatory support, mortality and pneumonia were significantly reduced to 6.5 (1-25) days in group I (mortality rate 0%, incidence of pneumonia 10%) compared to group III (duration of ventilatory support 26.7 days, mortality rate 39%, incidence of pneumonia 16%). Eighty percent of the patients in group I were extubated within 5 days postoperatively. In group II 4 patients underwent emergency thoracotomy for intrathoracic injuries (3 of them died between 4 h and 31 days) and 2 patients for laceration of the lung. In all these cases the chest wall was stabilized after thoracotomy. One patient was stabilized for a deformation of the chest wall and two for paradoxical movement of the chest wall during weaning from the respirator. The mean duration of ventilation in group II was 30.8 (10-112) days (mortality rate 30%, incidence of pneumonia 30%). No complications related to the osteosynthesis arose during the follow-up. In conclusion, the best indication for early operative chest wall stabilization is flail chest without pulmonary contusion, leading to a significant reduction in the duration of ventilatory support. Secondary stabilization is recommended in patients with pulmonary contusion showing paradoxical movement of the chest wall during weaning from the respirator.

Adult↗
PubMed2001

X-irradiation of the contusion site improves locomotor and histological outcomes in spinal cord-injured rats.

We have determined whether X-irradiation of the injury site can oppose tissue loss and improve recovery of locomotor function following contusion injury of the spinal cord. Contusion injury was produced in rats at the level of T10 with a weight drop device. Localized X-irradiation (20 Gy) of the injury site was performed at 20 min and 1, 2, 4, 7, and 17 days postinjury. Locomotor recovery was then determined with the 21-point Basso, Beattie, and Bresnahan (BBB) scale. X-irradiation enhanced recovery of locomotor function during a subsequent 6-week observation period when administered 20 min and 1 or 2 days following contusion injury (final BBB score approximately 7-8). X-irradiation at 4-17 days postinjury did not significantly affect final locomotor scores compared with unirradiated rats (final BBB score approximately 2), in marked contrast to previous studies where X-irradiation applied only at 17-18 days benefitted transection injury. The extent of recovery was directly related to measurements of sparing of spinal cord tissue at the contusion center. Because the treatment time window occurred earlier in contusion than reported for transection injury, the results suggest that contusion injury rapidly initiates underlying radiation-sensitive processes that occur only following a delay of several weeks after transection injury. Further optimization of X-ray treatment may lead to a useful therapeutic modality for use in spinal cord contusion injury.

Animals↗
PubMed2000

Heterogeneous mechanisms of early edema formation in cerebral contusion: diffusion MRI and ADC mapping study.

Severe cerebral contusion is sometimes associated with early edema formation within 24-48 hours post-trauma, and this frequently results in progressive ICP elevation and clinical deterioration. To investigate the underlying mechanisms of such severe contusion edema, diffusion imaging and ADC mapping were performed in 20 patients with cerebral contusion, employing 1.5 T echo planar MRI. Within 24 hours post-trauma, the diffusion images demonstrated a low intensity core in the central area and a high intensity rim in the peripheral area of contusion. The ADC value increased in the central area (ADC ratio (contusion/normal brain) = 1.13 +/- 0.13) and decreased in the peripheral area (ADC ratio = 0.83 +/- 0.13). This suggested that intra- and extracellular components underwent disintegration and homogenization within the central area, whereas cellular swelling was predominant in the peripheral area. A crescent-shaped zone of very high ADC value (ADC ratio = 1.38-1.61) was observed at the border between these two areas during the period of 24-48 hours post-trauma in some cases, apparently indicating that edema fluid was accumulated within a space formed by homogenization. The ADC values in the peripheral area shifted to an increase after 48-72 hours post-trauma. These findings imply that multiple mechanisms operate in early edema formation in cerebral contusion. It appears that the capacity for edema fluid accumulation increases in the central area and resistance for edema fluid propagation is elevated by cellular swelling in the peripheral area. We suggest that a combination of such events facilitates edema fluid accumulation in the central area and contributes, together with the cellular swelling in the peripheral area, to the mass effect of contusion edema. Diffusion MRI and ADC mapping represent powerful tools for investigating spatially as well as temporally heterogeneous mechanisms of contusion edema.

Brain↗
PubMed1996

Increase of insulin-like growth factor (IGF)-1, IGF binding protein-2 and -4 mRNAs following cerebral contusion.

The insulin-like growth factor (IGF) system has a role in repair following hypoxic-ischemic injury in many tissues including the brain. To study the involvement of the IGF system following head trauma, we used a rat contusion model, which produces a focal lesion of the cerebral cortex. Molecules in the IGF system were analyzed using in situ hybridization at different times following impact. We observed a dramatic up-regulation of insulin-like growth factor binding protein-2 (IGFBP-2) mRNA in cortical areas adjacent to the injury 24 h after impact, with a peak 10-fold increase engaging most of the ipsilateral cortex 2 and 3 days post-contusion. Seven days after the contusion, IGFBP-2 expression was only moderately up-regulated and again concentrated around the injury. IGFBP-4 mRNA levels increased 4-fold ipsilateral to the site of injury, with retained pattern of cortical expression. IGFBP-3, IGFBP-5 and IGFBP-6 mRNA all displayed distinct expression patterns in the brain but no significant changes were observed following injury. In contrast, IGF-1 mRNA levels were very low prior to contusion, but increased markedly at the site of injury with a peak at day 3. We were unable to detect any changes in the type 1 IGF-receptor or IGF-2 mRNA following contusion. The neuropeptide cholecystokinin (CCK) mRNA was clearly up-regulated following contusion, with an even distribution over the ipsilateral cortex. The expression pattern of molecules in the IGF system post-contusion differs in part to changes observed following hypoxic-ischemia or ischemia alone, perhaps reflecting different regulatory mechanisms depending on the type of injury.

Animals↗
PubMed1999

Microangiographic changes following cerebral contusion in rats.

The purpose of this study was to investigate the acute changes due to cerebral contusion in the large vessels and microvasculature in the rat. Thirty adult Sprague-Dawley rats underwent craniectomy performed in the left parietal region, producing a burr hole approximately 8-12 mm in diameter. The dura was left intact and a solid glass rod with a base diameter of 6 mm and weighing 5.2 g was dropped on the brain. Silicone rubber perfusion was performed at 24 h (10 rats) and 48 h (10 rats). Ten rats served as normal controls. The perfused brains were cleared using the alcohol-methylsalicylate technique. The results showed that the arterial and venous systems were clearly visualized by silicone rubber microangiography in the normal rat. Silicone rubber microangiography provided an excellent three-dimensional method for defining the distribution of the vasculature of the normal and contusioned rat brain, and was helpful in elucidating the pathophysiology of post-traumatic ischemia and hemorrhages of the brain. The brain displayed marked ischemia and hemorrhage at the contusion site. The hemorrhages were distributed throughout regions of white and gray matter at the injury site. All contusioned animals of those superficial arteries were irregularly filled or unfilled. The present study suggests that the pathogenesis of the post-traumatic brain may be related to damage of the superficial arteries and their arterial branches. Comparison of the brains from animals killed at 24 and 48 h following contusion revealed that the contusion was more severe 24 h after the vascular damage than after 48 h. Therefore, in the brains that were killed at 48 h, the contusion site was less avascular than those at the earlier times.

Animals↗
PubMed1994

Electrophysiologic assessment of intracerebral contusions in closed head injury.

To determine whether intracerebral contusions should be evacuated in severe closed head injuries, patients with Glasgow Coma Scale scores < or = 8 and with radiologic evidence of midline shift on computed tomography admitted from 1987 through 1993 to our intensive care unit were monitored with median nerve somatosensory evoked potentials (SSEPs). A total of 44 patients and 84 hemispheres were included in the study. Initial SSEPs, calculated by a quantitative peak-peak amplitude method, were not significantly different between hemispheres that contained localized contusions > or = 2.5 cm, those that had evidence of diffuse injury or punctate lesions < 2.5 cm not considered suitable for surgical evacuation, and those without evidence of parenchymal hemorrhage (mean 14.64 microV, p = 0.43). The SSEPs deteriorated 41.2% from initial baseline levels in diffusely injured and 22.6% in contused hemispheres, whereas in normal-appearing hemispheres, SSEPs improved 51.1% (p = 0.01). The difference in SSEPs, however, was not significant between the contused and diffusely injured hemispheres. The results suggest that in severe closed head injury, cerebral hemispheres without radiologic evidence of structural damage have a high likelihood of improving after initial impact injury. Furthermore, hemispheres with localized contusions showed no more deterioration than those with more diffuse injury, implying that hemispheric electrical deterioration is not related to size of localized contusions but rather to underlying axonal damage. This indicates that surgical evacuation of localized contusions unless accompanied by mass effect is probably not warranted.

Adolescent↗
PubMed2002

Blood flow and ischemia within traumatic cerebral contusions.

OBJECTIVE: To provide evidence of irreversible ischemia in cerebral contusions among patients with severe traumatic brain injuries and to clarify the potential viability of tissue in the pericontusional zone, quantitative regional cerebral blood flow (rCBF) measurements obtained with the xenon-enhanced computed tomographic method were correlated with the areas of contusions, by using image fusion. METHODS: rCBF measurements obtained during the acute phase (mean, 2 d after injury; range, 0-10 d) were statistically correlated with the extent of tissue necrosis identified as focal atrophy on late follow-up computed tomographic scans (mean time after the xenon-enhanced computed tomographic cerebral blood flow investigation, 265 d; range, 30-1047 d). RESULTS: Seventeen patients exhibited 26 traumatic contusions. All contusions progressed to late focal atrophic areas on the follow-up computed tomographic scans. The rCBF values within the traumatic contusions ranged from 0.5 to 22.0 ml/100 g/min, with a mean of 5.9 +/- 5.9 ml/100 g/min. The contusions exhibited a specific rCBF profile, presenting as a core of severe lethal ischemia surrounded by variable but gradually increasing perfusion with increasing distance from the ischemic core. CONCLUSION: The ischemic profile of the contusions, with a pericontusional zone of low rCBF, presents the potential risk of secondary ischemic insults, similar to the risk in the ischemic penumbral zones surrounding areas of acute ischemic stroke.

Adolescent↗
PubMed1988

MR imaging of brain contusions: a comparative study with CT.

Ninety-eight brain contusions in 17 patients served as a data base for a comparative study of MR and CT for defining brain contusions. MR was the more sensitive technique, detecting 98% of the brain contusions compared with only 56% by CT. CT was slightly better for showing hemorrhagic components, documenting 77% of hemorrhages compared with 71% for MR. The appearance of the contusions on MR was variable, depending on the T1- and T2-weighting of the images and the constituents of the contusions, such as edema, hemorrhage, and encephalomalacia. On MR, hemorrhagic components appeared as high signal on T1-weighted images and as either low or high signal on T2-weighted images, depending on the age of the hemorrhage. The approximate ages of hemorrhagic contusions were often suggested by their appearance on T1- and T2-weighted images. CT is very effective for evaluating acute head trauma, but MR is recommended for documenting brain contusions during the subacute and chronic stages of head injuries.

Adolescent↗
PubMed2002

[Brain contusion: morphology, pathogenesis and treatment].

Focal cerebral contusions can be dynamic and expansive, leading to a delayed neurological deterioration. In head--injured patients, the rise in intracranial pressure (ICP), subsequent to uncontrollable swelling, is the only and the most frequent cause of death. Studies show that brain swelling, after traumatic brain injury (TBI), is caused by brain edema rather than cerebral blood volume (CBV). CBV is reduced in proportion to cerebral blood flow (CBF) reduction, following a severe TBI. Cerebrovascular damages, leading to subsequent reductions in regional CBF, may play an important role in secondary cell damages following TBI. The histological examination revealed the formation of microthrombosis in the contused area, extending from the center to the peripheral areas within 6 hours after injury. In the pericontusional zone and surrounding parenchyma, vasoresponsivity may be nearly three times normal, which suggests hypersensitivity to hyperventilation and other phenomena. Glutamate is the most widely distributed excitatory neurotransmitter in the mammalian brain. However, when glutamate is present in excessive quantities, it may overactivate specific ion channels, especially the N-methyl-D-aspartate channel. A shift of potassium into the extracellular space will result in rapid swelling of astrocytes, which absorb quantities of potassium to preserve ionic homeostasis. This process may cause rapid cytotoxic edema, which is probably, a major factor in causation of posttraumatic raised ICP. The presence of a focal contusion and primary or secondary ischemic events were the clinical features most strongly correlated with high dialysate of glutamate. Raised ICP was significantly more common, and outcome was worse in patients with high levels of glutamate. Contusion is a key factor in the development of blood brain barrier (BBB) permeability. BBB endures at least 7 days post TBI. Biphasing opening of the BBB, following head trauma and a possible second wave of secondary brain damage, was confirmed. Brain tissue pO2 monitoring might become an important tool in the treatment regime for TBI patients. Histologically the loss of CA3 pyramidal cells in the hippocampus was observed ipsilaterally in the cortical contusion and bilaterally in diffuse axonal injury. Aggressive, early hyperventilation after TBI augments neuronal death in CA3 hippocampus. Due to high mortality associated with such cerebral contusions, a standard practice has evolved into evacuating contusions in patients who had deterioration in the level of consciousness, lesions more than 30 sec and CT suggestion of raised ICP.

Blood-Brain Barrier↗
PubMed1976

[Coxarthrosis due to contusion].

Can a contusion cause coxarthrosis in the absence of both fracture and dislocation? Yes. To demonstrate this the authors report 6 cases that fulfil the following conditions: (1) Simple but violent contusion affecting the greater trochanter or the knee (dashboard accident) or a forced movement, such as in doing the splits; (2) immediate or slightly delayed pain, generally of short duration (a few weeks); (3) absence of coxarthrogenic malformations and absence of pre-existing signs of a pathological hip condition; (4) progressive coxarthrosis on the side of the contusion; (5) chronological relation between the development of the coxarthrosis images and the date of the contusion; (6) subjects less than 35 years of age, in order to eliminate cases with latent primary pre-coxarthrosis. The average age of the six patients at the start of the coxarthrosis was 24.7 years (range: 13 to 33 years); there were four men and two women. In five of the six cases a violent contusion in the trochanter region was involved as a result of a fall on a hard surface or a traffic accident. In one case a forced movement on landing from a jump was involved. Evolution in three periods is usual: the hip is painful either immediately or after a few weeks (particularly on rising after a period in bed for multiple injuries). This post-traumatic pain lasts from ten days to one month, rarely longer. It is followed by a period free of pain that may last from five months to ten years (average: five years). Subsequently there is pain every day and the onset of the limp associated with coxarthrosis. Radiographically the reduction of the joint space and/or the osteophytosis appears after three months to two years (average: one year). However, there may not be any pain associated with these lesions for a long time. The authors propose that the first five conditions enumerated above represent the essential medico-legal conditions of coxarthrosis by contusion. The restriction as regards age (No 6) was introduced only to show clearly the existence of post-contusive coxarthrosis. However, even if one or more of the medico-legal conditions are not fulfilled the imputability may still be valid. Some such cases are discussed.

Adolescent↗
PubMed1978

[Neurological and EEG-follow-up studies in head-injured adults: criteria for the clinical diagnosis concussion and contusion (author's transl)].

A stystematic neurological and electroencephalographical follow-up study in 344 head injured adults gave the following results: 1. 52% of all the hospitalized (mostly primarily amnesic) patients had a cerebral contusion. A contusion was assumed in cases with focal neurological signs (13%), amnesias of more than 8 hours (16%) and/or EEG-abnormalities lasting for more than 24 hours (49%). 2. Traumatic EEG-abnormalities were general slowing (43%) and foci (32%). In 40% of the cases with general slowing the slowing (greater than or equal to 1.5/sec) was within the alpha-frequency band and could only retrospectively be assed. 3. The EEG was invariably abnormal in cases with an amnesia exceeding 8 hours. If the amnesia exceeded 1 hour abnormalities were found in 73%. 4. Among the patients with contusion 6.5% had no amnesia, 48% less than 30 minutes and only 30% an amnesia for more than 8 hours. In 75% of the patients with concussion amnesia lasted less than one hour. 5. Skull fractures were mostly combined with contusion (74%). 6. Impaired drive, reduced ability to concentrate, memory deficits, headache and dizziness were significantly more frequent 6 months after contusion than after concussion. 7. 21% of the patients with traumatic dizziness (44%) had a labyrinthine contusion. 8. Among the contusions diagnosed with the aid of EEG recordings 58% would have been missed after exclusive neurological examination and 82% after application of the classical criteria used by surgeons and general practitioners.

Adolescent↗