Question

You are at the scene of a motor vehicle accident. There is a 12 y/o girl who has a large contusion on her left frontal area. She is confused as to what has happened. What would you want to assess initially? If this child is now in your emergency room, what signs and symptoms would indicate a worsening condition? What teaching would be important for someone being discharged home after sustaining a concussion?

Answer 1

Contusions are likely to heal on their own without medical intervention.[

Signs and symptoms

The symptoms of a cerebral contusion depend on the severity of the injury, ranging from minor to severe. Individuals may experience a headache, confusion, sleepiness, dizziness, loss of consciousness, nausea and vomiting, seizures, difficulty with coordination and movement, lightheadedness, tinnitus, and spinning sensations. They may also have difficulty with memory, vision, speech, hearing, managing emotions, and thinking.signs also depend on the contusion's location in the brain.

Contusions, which are frequently associated with edema, are especially likely to cause increases in intracranial pressure (ICP) and concomitant crushing of delicate brain tissue. They typically form in a wedge-shape with the widest part in the outermost part of the brain. The distinction between contusion and intracerebral hemorrhage is blurry because both involve bleeding within the brain tissue; however, an arbitrary cutoff exists that the injury is a contusion if two thirds or less of the tissue involved is blood and a hemorrhage otherwise.

The contusion may cause swelling of the surrounding brain tissue, which may be irritated by toxins released in the contusion.The swelling is worst at around four to six days after the injury. Extensive contusion associated with subdural hematoma is called burst lobe.Cases of a burst frontal or temporal lobe are associated with high mortality and morbidity.

Old or remote contusions are associated with resorption of the injured tissue, resulting in various degrees of cavitation, in addition to the presence of a golden-yellow discoloration due to residual hemosiderin. These remote contusions are often referred to as plaque jaune or yellow plaque.

Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of hypotension (low blood pressure), hyponatremia (insufficient sodium), and hypercapnia (increased carbon dioxide in the blood).Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it. People with cerebral contusion may require intensive care and close monitoring.