Diagnosing a Contusion Cerebral - Oren Zarif - Contusion Cerebral
The diagnosis of a contusion cerebral depends on how severe the injury is. A mild traumatic brain injury, such as a concussion, may be diagnosed with a CT scan. More serious brain injuries, such as a ruptured aneurysm, will require immediate evaluation in the emergency room. For a more comprehensive evaluation, a CT scan may be indicated. However, it may be difficult to obtain accurate results from a cranial CT without the aid of a brain aneurysm.
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A cerebral contusion can range from a tiny punctate injury to a confluent edematous injury. Most often, it affects the temporal and frontal lobes, and it is more common to occur in areas of the brain that are in contact with uneven bone surfaces. Those bones include the ethmoid cribiform plate and the petrous ridges. In severe cases, a patient may experience seizures, coma, or even a stroke.
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Although a patient is unlikely to require surgery immediately after a concussion, he or she may need anti-seizure medications and antibiotics. Since any device placed inside the patient can introduce microbes, an anti-infection medication is also a must. If a patient's neurological condition does not improve, or if the ICP is elevated, surgery may be necessary. The effects of a cerebral contusion vary widely, with some people recovering nearly completely while others suffering from significant disability.
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While concussions may cause temporary loss of consciousness, a contusion usually requires hospitalization. Almost 20-30 percent of serious head injuries result in cerebral contusion. In the case of severe concussions, the person will lose consciousness for 15 minutes. In addition, a concussion may be accompanied by multiple microhemorrhages. However, a cerebral contusion is more severe than a concussion, as it involves structural brain damage.
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A cerebral contusion is a bruised area of brain tissue. It may develop anywhere in the brain, but most commonly affects the frontal and temporal lobes. A typical hemorrhagic cerebral contusion can extend to the subcortical white matter and the white/gray border of the brain. If untreated, a contusion can progress to necrosis, cavitation, and reactive gliosis.
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A cerebral contusion is similar to a bruise in other parts of the body. It occurs when the brain strikes a fold in the dura mater or a ridge in the skull. A cerebral contusion is typically associated with other types of bleeding. A cerebral edema develops around a contusion within 48 hours of an injury. A computed tomography brain scan is the best way to diagnose a contusion.
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A medical team specializing in head and abdominal imaging will diagnose a cerebral contusion with CT scan. CT scans are the mainstay for imaging acute TBI. The term TBI encompasses a wide range of brain injuries, including cerebral contusion. It is important to remember that a brain contusion is a type of head injury, and should be evaluated by a radiologist. In the event of a severe brain injury, a CT may be inconclusive and require surgery.
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The CT grade and basal cistern status will be used to determine a patient's prognosis. These two variables may influence the severity of the contusion and the outcome. Nonetheless, the presence or absence of a basal cistern or edema band will likely determine a patient's prognosis. If there is no basal cistern or a leaking shunt, the patient will be expected to recover.
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A decompressive craniectomy is performed when excessive intracranial pressure is life threatening. This type of surgery removes a large portion of the skull and allows the brain to swell. Special biologic tissue is then placed over the exposed brain. The skin is then closed over the bone flap. After the procedure, the surgeon will remove the bone flap and replace it with a bone flap in a subsequent procedure, called cranioplasty.