KONTUSIO SEREBRI

DAVE
ORLANDO
GUMAY

DEFINITION
Kontusio cerebri merupakan memar di jaringan otak
akibat trauma.
Seperti memar pada jaringan lain, memar cerebral
dapat dikaitkan dengan beberapa microhemorrhages,
terjadi akibat kebocoran PD kecil ke jaringan otak.

EPIDEMIOLOGY
Common type of primary intra-axial lesion . In 21% of
head trauma patients.

PATHOGENESIS
1. COUP :- Direct impact to stationary brain. Injury at
the site of impaction
2. COUNTER COUP :- Impact of moving brain on
stationary clavarium opposite to the site of the coup
and produced injury

 Tissue necrosis, capillary disruption, petechial

hemorrhage followed by liquefaction + oedema after
4 to 7 days .contusion may be hemorrhagic or nonhemorrhagic.
Petechial hemorrhage of gyri small hemorrhage
large hematoma

LOCATION
Multiple bilateral lesion,temporal lobe more
frequently involved
Temporal lobe - anterior tip, inferior surface, sylvian
region
Frontal lobe - anterior pole, inferior surface
Dorsolateral midbrai
Inferior cerebellum

CLINICAL MANIFESTATION
weakness, lack of motor coordination, numbness,
aphasia and memory cognitive problems. Signs
depend on the contusion's location in the brain

CT
Initial fi ndings may be subtle or absent.
Early fi ndings focal / multiple poorly defi ned areas of
low attenuation with irregular contour intermixed with
a few tiny areas of increased density ( petechial
hemorrhage)
MOTTLE / speckled density ,salt and pepper on CT
Diff use oedema and mass eff ect in immediate posttraumatic period,then gradually diminish over time.
Some degree of contrast enhancement. - Isodense to
brain after 2 3 weeks.

E N L A R G E M E N T O F A N A C U T E B RA I N C O N T U S I O N . ( A ) A X I A L C T
S C A N O B TA I N E D O N DAY 1 A F T E R H E A D T RA U M A S H O W S A
S U B T L E A R E A O F S L I G H T LY H Y P O AT T E N U AT I N G R I G H T F R O N TA L
LO B E C O N T U S I O N ( A R R O W S ) W I T H A S M A L L , O V E R LY I N G , R I G H T
F R O N TA L S U B D U RA L H E M AT O M A . N O T E T H AT T H E S C A L P
H E M AT O M A S I N T H E F R O N TA L A N D T E M P O RA L R E G I O N S
I N D I C AT E A R E A S O F D I R E C T F O RC E . ( B ) C O M PA N I O N A X I A L C T
S C A N O B TA I N E D O N DAY 2 S H O W S A L A R G E , R I G H T F R O N TA L
C O N T U S I O N ( A R R O W ) A N D A N E W , L A R G E , L E F T T E M P O RA L
C O N T U S I O N ( A R R O W ) . N O T E T H AT T H E S C A L P H E M AT O M A S H AV E

 Re s o l u t i o n o f a b r a i n c o n t u s i o n . ( A ) A x i a l C T s c a n o b t a i n e d o n d a y 1
a ft e r a h i g h - s p e e d m o t o r v e h i cl e a c c i d e n t s h o w s s u b t l e e v i d e n c e o f
b i f ro n t a l h e m o rrh a g i c c o n t u s i o n s ( a rro w s ) . ( B ) A x i a l C T s ca n o b t a i n e d
o n d a y 2 s h o w s i n c re a s e d h e m o rrh a g e w i t h i n t h e i n f e r i o r f ro n t a l c o r t ex
b i l a t e r a l l y ( a rro w s ) . ( C ) A x i a l C T s ca n o b t a i n e d o n d a y 1 4 s h o w s
re s o l u t i o n o f t h e b r i g h t b l o o d ( u p p e r a rro w s ) a n d re s i d u a l a re a s o f d a r k
e d e m a i n b o t h f ro n t a l l o b e s a n d a s u b t l e a re a t h ro u g h o u t t h e r i g h t
t e m p o r a l l o b e ( l o w e r a rro w s ) .