Coup-Contrecoup Mechanism of Craniocerebral Injuries

SYNOPSISThe cognitive abilities of right-handed men who had sustained a severe closed head injury between 10 and 20 years earlier were studied. Results showed that a right-sided impact produced greater deficits than a left-sided impact in both verbal and non-verbal skills. The results are interpreted as reflecting left hemisphere damage due to contrecoup injury. Some evidence that a left frontal impact was apt to result in defective visual-spatial functioning is presented. These observations accord with some theories on the mechanics of head injury and with observations on the predictability of sites of cerebral contusion in brain injury uncomplicated by dural penetration, intracranial infection, or cerebral infarction. The roles of the duration of post-traumatic amnesia, the level of neurological responsiveness at the time of admission to hospital, and the age at which the injury was sustained are also discussed.

Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 92%

Influence of site of impact on cognitive impairment persisting long after severe closed head injury

Smith

1974

“…Temporal contre-coup lesions are common in severe head injuries (Courville, 1942), and temporal lobe damage bears a special relationship to aphasia and, to some extent, to psychiatric disability (Lishman, 1966).…”

Section: Discussionmentioning

confidence: 99%

Evaluation and outcome of aphasia in patients with severe closed head trauma.

Thomsen¹

1975

SYNOPSIS In this study long-term observation of 12 patients with aphasia secondary to severe closed head trauma took place. The most frequent symptoms were amnestic aphasia and verbal paraphasia. Only one patient with a constant slow wave EEG focus in the dominant hemisphere had severe receptive symptoms. In all other patients the aphasia recovered rather well, though not totally, but the presence and degree of concomitant neuropsychological disorders were most important for the final outcome.The relationship between head injury and loss of speech has been known for thousands of years as seen in the reports of the Egyptian surgeons between 3 000-2 500 BC (Breasted, 1930). Descriptions of such cases have, however, been few until the time of the first and second world wars. During these periods a great amount of literature on post-traumatic aphasia secondary to penetrating wounds was published. In contrast with this abundant literature, the paucity of works on post-traumatic aphasia in peace time is striking, and this is especially true in cases of aphasia secondary to closed head injuries.The purpose of this study has been to evaluate the types of aphasia that occur after severe concussion and to study the outcome of the language disturbances. In contrast with an investigation by Heilman et al. (1971), in which the period of observation was rather short, systematic followup of the patients in this series has been carried out for a long time. METHODSSUBJECTS In a series of 50 head patients with head injuries the only criterion of selection was the severity of the trauma, all patients being deeply unconscious for more than 24 hours. Twenty-four of the patients had focal lesions and 26 had closed head trauma. Twelve of the last-mentioned patients, five 1 Address for reprints:

“…The preponderance of right orbitofrontal trauma in our aphasic patients is probably somewhat dependent on the higher incidence of frontal trauma in our popula- tion, in addition to a selective vulnerability of the right orbitofrontal region as compared with the left. Courville (1942) and others have noted that the dorsolateral surface of the temporal lobe was a frequent site of contusion, whereas other regions of the speech area, including the frontal and parietal opercula, were rarely contused. In our series, a parietal lobe contusion was seen in one case at postmortem examination and in another case a contusion of the dorsolateral temporal lobe was seen during the removal of a subdural haematoma.…”

Section: -3mentioning

confidence: 91%

Closed head trauma and aphasia

Heilman

Safran

Geschwind

1971

119

SUMMARY A prospective study has been done on the relationship between closed head trauma and aphasia. The most frequent type of aphasia seen after closed head injury is an anomic aphasia. This aphasia is often associated with other defects of higher cortical function. The second most common type of aphasia is a Wernicke's aphasia. Other types of aphasia were not seen in this study. The areas of the head which when injured produce aphasia are the right orbitofrontal region and the left temporoparietal region. The prognosis for recovery appeared highly variable.