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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 374-379
DOI: 10.1055/s-0043-1776992
Original Article

Outcome and Management of Occipitofrontal Contrecoup Head Injury

Syamantak Srivastava 
1   Department of Neurosurgery, Madurai Medical College & Government Rajaji Hospital, Madurai, Tamil Nadu, India
,
Ganapathyvel Kannan
2   Department of Neurosurgery, Thoothukudi Medical College & Hospital, Thoothukudi, Tamil Nadu, India
,
J. Srisaravanan
1   Department of Neurosurgery, Madurai Medical College & Government Rajaji Hospital, Madurai, Tamil Nadu, India
,
K. Rajaraajan
1   Department of Neurosurgery, Madurai Medical College & Government Rajaji Hospital, Madurai, Tamil Nadu, India
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Abstract

Contrecoup brain injury refers to the classical opposite of the primary impact. Tamil Nadu has the highest rate of road traffic accident in India. Madurai has peak mortality due to accidents in India. Previous studies done on contrecoup head injury had shown patterns of injuries and mechanism of injury. Outcome and management of only occipitofrontal contrecoup head injury has been taken in this study. Mortality in this specific group is very high. Seventy-six patients of this specific head injury were admitted at Government Rajaji Hospital, Madurai. Patients were assessed for Glasgow coma scale (GCS), age, sex, progression of volume, mortality, traumatic brain injury-induced coagulopathy, and pillion rider outcome. Fourteen patients were surgically treated by decompressive craniectomy. Conservative management was done by antiepileptic and antiedema measures. Mostly affected were males (n = 54) followed by females (n = 22). GCS on admission mean value 9. In our study, mortality was 32% with sudden death of three patients due to hypothalamic compression. Hospital stay of the patient was significantly increased with progression of lesion with mean 9 days and p-value less than 0.01. Pillion riders (n = 18) were also affected in our study. Traumatic brain injury-induced coagulopathy (n = 12) was also detected, which was treated by injection tranexamic acid and injection vitamin K, thereby not leading to any death due to coagulopathy with significant p-value less than 0.01. We recommend helmet for both main and pillion rider with strict speeding regulations.

Keywords

contrecoup head injury - frontal hemorrhagic contusion - mortality - occipital bone fracture - pillion rider - traumatic brain injury-induced coagulopathy - road traffic accidents


Publication History

Article published online:
25 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Courville CB. Contrecoup injuries of the brain in infancy. Arch Surg 1965; 90: 157-165
    CrossrefPubMedGoogle Scholar
  • 2 Drew LB, Drew WE. The contrecoup-coup phenomenon: a new understanding of the mechanism of closed head injury. Neurocrit Care 2004; 1 (03) 385-390
    CrossrefPubMedGoogle Scholar
  • 3 Allen FJ. The mechanism of contrecoup and of certain other forms of intracranial injury. BMJ 1896; 1 (1846) 1196-1197
    CrossrefPubMedGoogle Scholar
  • 4 Bayly PV, Cohen TS, Leister EP, Ajo D, Leuthardt EC, Genin GM. Deformation of the human brain induced by mild acceleration. J Neurotrauma 2005; 22 (08) 845-856
    CrossrefPubMedGoogle Scholar
  • 5 Goggio AF. The mechanism of contrecoup injury. J Neurol Psychiatry 1941; 4 (01) 11-22
    CrossrefPubMedGoogle Scholar
  • 6 Cepeda S, Gómez PA, Castaño-Leon AM, Munarriz PM, Paredes I, Lagares A. Contrecoup traumatic intracerebral hemorrhage: a geometric study of the impact site and association with hemorrhagic progression. J Neurotrauma 2016; 33 (11) 1034-1046
    CrossrefPubMedGoogle Scholar
  • 7 Mahapatra AK, Jaiswal A. Epidemiology of head injury. Neurosci Today 2003; 7: 29-32
    Google Scholar
  • 8 Graham DI, Lantos PL. Greenfield's Neuropathology. 7th ed. London:: Arnold; 2002
    Google Scholar
  • 9 Kraus JF. Epidemiology. In: Elizabeth F, ed. Head Injury Clinical Management and Research. Geneva, Switzerland: AIREN; 1990: 113-124
    Google Scholar
  • 10 Bhateja A, Shukla D, Devi BI, Sastry KV. Coup and contrecoup head injuries: predictors of outcome. Indian J Neurotrauma 2009; 6 (02) 115-118
    Article in Thieme ConnectGoogle Scholar
  • 11 Banga MS, Sandeep BV, Roy K, Saha KS, Dixit S, Ghosh P. Contrecoup head injury. Indian J Neurosurg 2017; 6: 103-106
    Article in Thieme ConnectGoogle Scholar
  • 12 Jayakumar PN, Sastry Kolluri VR, Basavakumar DG. et al. Prognosis in contre-coup intracranial haematomas–a clinical and radiological study of 63 patients. Acta Neurochir (Wien) 1991; 108 (1-2): 30-33
    CrossrefPubMedGoogle Scholar