Prognosis in contre-coup intracranial haematomas ? a clinical and radiological study of 63 patients

Jayakumar, P. N.; Kolluri, V. R. Sastry; Basavakumar, D. G.; Subbakrishna, D. K.; Arya, B. Y. T.; Das, B. S.; Reddy, G. N. Narayana

doi:10.1007/bf01407663

Cited by 9 publications

(12 citation statements)

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“…In this study comprising of cases of only contrecoup injuries, the mortality was 41% in patients less than 40 years and 67% in patients more than 40 years of age. Mortality for bilateral contusions was 79% in this study 12 . Comparable figures in the present study, for patients less than 40 years were 43.9% and for patients more than 40 years was 35.4%, for contrecoup injuries.…”

Section: Discussionsupporting

confidence: 45%

“…The overall mortality of patients aged 40 years or less was 14%, aged 41-60 was 18.4% and patients aged more than 60 years was 55%. Jayakumar et al found contrecoup injuries in 9.6% of their 650 patients 12 . In this study comprising of cases of only contrecoup injuries, the mortality was 41% in patients less than 40 years and 67% in patients more than 40 years of age.…”

Section: Discussionmentioning

confidence: 95%

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Coup and contrecoup head injuries: Predictors of outcome

Bhateja

Shukla

Devi

et al. 2009

The Indian Journal of Neurotrauma

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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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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 95%

Coup and contrecoup head injuries: Predictors of outcome

Bhateja

Shukla

Devi

et al. 2009

The Indian Journal of Neurotrauma

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“…Most had associated lesions. Associated intracranial hematoma, poor Glasgow coma scale and increasing age caused increased mortality in these patients 5 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Craniocerebral Trauma Using Computed Tomography

S¹,

Shetty²

2014

IOSRJDMS

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Aims And Objective:Objective of the present study is to evaluate and assess the role of computed tomography in patients with craniocerebral trauma in respect to: study the different traumatic lesions in trauma to the head  to establish that CT has a significant role in management of patients with head injury  to assess the prognostic significance of CT in outcome of patients of head injury. Methods:This is a prospective analysis of 100 patients with craniocerebral trauma using computed tomography who were treated at our institution from Nov 2009 to Oct 2011. Findings of the computed tomography using Helical CT scanner, GE CT machine were computed and compiled. Result: The results of the study revealed that the incidence of craniocerebral trauma was more in male population. The peak incidence of age was found in the age group of 18-30 years. Although fractures and contusions constituted about 84.6% and 57% respectively, subdural hematoma was commonest cause of morbidity and mortality in craniocerebral trauma forming about 32.1% followed by extradural hematomas 12.5% Conclusion: Computed Tomography is one of the comprehensive diagnostic modality for accurate localisation of the site of injury in acute craniocerebral trauma. The early and timely diagnosis of the precise lesion by CT not only had substantial impact over instituting appropriate treatment and timely surgical intervention but also helped in predicting the ultimate outcome.

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“…Traumatic acute bilateral mass-occupying lesions (TABML) is a common entity after contre-coup injury, with an estimated mortality ranging from 20% to 79%; however, the optimal treatment options and the prognostic indicators for TABML are largely unknown [ 4 , 5 , 8 – 12 ]. Whether all patients with TABML will benefit from surgical intervention and, if surgery is performed, whether surgical intervention should be based on predominantly mass-occupying lesions (unilateral) or bilateral lesions [ 5 , 7 – 10 , 13 ], remain under discussion.…”

Section: Introductionmentioning

confidence: 99%

Acute bilateral mass-occupying lesions in non-penetrating traumatic brain injury: a retrospective study

Sun

Yuan

et al. 2015

BMC Surg

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BackgroundTraumatic acute bilateral mass-occupying lesions (TABML) is a common entity in head injury, with high morbidity and mortality. Our aim in this study was to evaluate the benefits of different treatment options and the outcome predictors in patients with TABML.MethodsFrom October 2010 to November 2012, a consecutive cohort of patients aged 16–70 years with TABML were retrospectively analyzed based on the clinical and radiological characteristics. Patients with TABML were included if admitted within 24 h after injury and were excluded if they presented with infratentorial lesions, unilateral lesions within the first 24 h after injury, or penetrating head injury. According to their treatment option, patients were divided into three groups: a conservative treatment group, a unilateral surgery group, and a bilateral surgery group. Outcomes were assessed using the Glasgow Outcome Scale (GOS). Binary logistic regression analysis was applied to determine the outcome predictors.ResultsForty-seven patients (58.8%) had severe injuries (Glasgow Coma Scale score (GCS), 3–8) upon admission, and the overall mortality was 31.3% at 6 months post-injury. The mortality was 55.6% in patients who underwent conservative treatment (N = 18), 17.9% in unilateral surgery patients (N = 39), and 34.8% in the bilateral surgery group (N = 23). In the surgical group, the mortality was 53.3% (8 of 15) in those with a GCS of 3–5, which decreased steeply to 14.9% (7 of 47) of those with GCS ≥ 6. On logistic regression analysis, the absence of pupillary reactivity, disappearances of basal cisterns and conservative treatment were related to higher mortality. A lower initial GCS score was associated with an unfavorable outcome. Midline shift tended to be associated with mortality and an unfavorable outcome, although statistical analysis did not show a significant difference.ConclusionsTABML is suggestive of severe brain injury. As conservative treatment is always associated with a poorer outcome, surgery is advocated, especially in patients with a GCS score of ≥ 6. Whereas the prognostic value of midline shift might be limited because of the counter-mass effect in TABML, the GCS score, the pupillary reactivity, and particularly, the compression of basal cisterns should be emphasized.

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Prognosis in contre-coup intracranial haematomas ? a clinical and radiological study of 63 patients

Abstract: The clinical and radiological profiles of 63 patients with contre-coup haematomas were studied. The overall mortality was 53%. The mortality in patients with contre-coup haematomas alone was only half of that found in patients with associated coup injury (80%).

Cited by 9 publications

References 9 publications

Coup and contrecoup head injuries: Predictors of outcome

Coup and contrecoup head injuries: Predictors of outcome

Evaluation of Craniocerebral Trauma Using Computed Tomography

Acute bilateral mass-occupying lesions in non-penetrating traumatic brain injury: a retrospective study

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