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DOI: 10.1016/S0973-0508(09)80004-X
Coup and contrecoup head injuries: Predictors of outcome
Verantwortlicher Herausgeber dieser Rubrik:
Publikationsverlauf
Publikationsdatum:
05. April 2017 (online)
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Abstract
Coup and contrecoup contusions comprise a group of focal brain injuries. The pathogenesis of the two are different, the outcome in the two would therefore be expected to be different. However there are no studies in literature comparing outcome in coup-contrecoup injuries. At NIMHANS, Bangalore, two hundred and ninety eight consecutive cases presenting with coup and contrecoup injuries over a 2-year period were retrospectively analyzed. They were divided into three groups: Coup injuries with intraparenchymal injury (n = 129), contrecoup injuries (n = 84) and coup-contrecoup injuries (n = 85). The groups were comparable with respect to age and GCS. Site of primary impact was determined by clinical and CT scan criteria. The mortality rates in each group were compared with respect to age, GCS and CT pattern. Significance was calculated using the chi-square test. There was a statistically significant difference in mortality between patients with coup injuries and patients with contrecoup (p < 0.005) and coup-contrecoup injuries (p<0.001). There was no significant difference in mortality between contrecoup and coup-contrecoup injuries (p = 0.1). Mortality in patients aged less that 60 years and patients with GCS > 8 was significantly higher in patients with contrecoup and coup-contrecoup injuries. Presence of a contrecoup component on CT scan may portend a worse outcome in head injuries and may warrant closer monitoring and more aggressive management of these patients.
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References
- 1 Adams JH, Gennarelli TA, Graham DI. Brain damage in nonmissile head injury: observations in man and subhuman primates. In, Smith WT, Cavangh JB. (eds): Recent advances in Neuropathology, No. 2. 1982. Churchill Livingstone; Edinburgh: 165-190
- 2 Gennarelli TA, Spielman GM, Langfitt TW. et al Influence of the type of intracranial lesion on outcome from severe head injury. A multicentre study using a new classification system. J Neurosurg 56 1982; 26-32
- 3 Gennarelli TA. Head injury in man and experimental animals: clinical aspects. Acta Neurochir (Wien) 32 Suppl 1983; 1-13
- 4 Gennarelli TA, Meaney DF. Mechanisms of primary head injury. In, Wilkins RH, Rengachary SS. (eds). Neurosurgery. 2nd . edition 1996. Mc Graw-Hill; 2611-2621
- 5 Servadei F. Prognostic factors in severely head injured adult patients with epidural haematomas. Acta Neurochir (Wien) 139 1997; 273-278
- 6 Servadei F. Prognostic factors in severely head injured adult patients with acute subdural hamatomas. Acta Neurochir (Wien) 139 1997; 279-285
- 7 Marshall LF, Marshall SB. Outcome prediction in severe head injury. In, Wilkins RH, Rengachary SS. (eds). Neurosurgery. 2nd . edition 1996. Mc Graw-Hill; 2611-2621
- 8 Marshall LF, Marshall SB, Klauber MR. et al A new classification of head injury based on computerized tomography. J Neurosurg 75 Suppl 1991; 14-S20
- 9 Lobato RD, Cordobes F, Rivas JJ. et al Outcome from severe head injury related to the type of intracranial lesion. A computerized tomographic study. J Neurosurg 59 1983; 762-774
- 10 Kotwica Z, Braezinskin J. Acute subdural haematomas in adults an analysis of outcome in comatose patients. Acta Neurochir (Wien) 121 1993; 95-99
- 11 Seelig JM, Becker DP, Miller JD. et al Traumatic acute subdural haematoma. Major mortality reduction in patients treated within four hours. New Eng J Med 304 1981; 1511-1518
- 12 Jayakumar PN, Kolluri Sastry VR, Basavakumar DG. et al Prognosis in contrecoup intracranial haematomas a clinical and radiological study of 63 patients. Acta Neurochir (Wien) 108 1991; 30-33