Cerebral Contusions and Lacerations

Cerebral contusions are bruises on the brain, usually caused by a direct, strong blow to the head. Cerebral lacerations are tears in brain tissue, which often accompany visible head wounds and skull fractures.

Cerebral contusions and lacerations are usually more serious than concussions. Contusions may be caused by the sudden acceleration of the brain that follows a jolt--as may be delivered by a forceful blow to the head--or by the sudden deceleration that occurs when a moving head strikes an immovable object. The brain can be damaged at the point of impact and on the opposite side by striking the inside of the skull. Acceleration-deceleration injuries are sometimes called coup contrecoup (meaning hit-counterhit in French).

Contusions and lacerations may cause only minimal physical damage to the brain, with few symptoms. However, if swelling or bleeding is severe, these injuries can cause a severe headache, dizziness, and vomiting. One pupil may be larger than the other. Depending on which area of the brain is damaged, the ability to think, control emotions, move, feel, speak, see, hear, and remember may be impaired. The person may become irritable, restless, or agitated. One side of the body may become weak or feel numb. Confusion may develop. A more severe injury causes swelling within the brain, damaging brain tissue further. Herniation of the brain may result, sometimes leading to coma. Severe brain damage is often accompanied by other injuries, especially scalp injuries, skull fractures, and injuries of the chest and spine.

Magnetic resonance imaging (MRI), which can detect physical damage to the brain, is performed. If bleeding is minor, rest is the only treatment needed, but the person must be observed for a period of days up to 1 week. If bleeding is severe, the blood may have to be removed surgically. Other injuries, if present, must also be treated.