Injury to the brain.

Brain injuries may be caused by:

• Penetration by foreign object such as knife, bullet etc. or by
fragments of skull in a depressed fracture.
• By distortion of the skull. When a localised segment of the
skull undergoes deformation, shear strains may develop in the
brain tissue underlying the indentation, and a contusion may
be produced in the surface layers of the brain tissue. If a
fracture occurs , pieces of bone may penetrate the dura and
lacerate the brain.
• Due to movement of brain in relation to the skull
Cerebral contusion
• When a localised segment of the skull undergoes deformation
at the moment of impact. Shear strains may develop in the
brain tissue underlying the indentation, and a zone of
contusion may be produced in the surface layers of the brain.
• Most often they occur in cerebral and cerebellar cortices and
subcortical areas.
Post-traumatic CT scan of brain showing
bilateral contusion of frontal cerebral region:
Types:
• Intermediary coup contusions: Contusions found in deeper
structures of the brain along the line of impact.

• Fracture contusions : Contusions caused due to fracture of the

skull.

• Gliding contusions : Contusions in the cortex and white

matter of frontal and central convolutions.

• Herniation contusions : Contusions in the cerebellar tonsils

and the medulla oblongata.
Cerebral laceration
• They are traumatic lesions in the brain in which there is loss of
continuity of the substance of the brain.
• When the parenchyma is completely disorganised, it is
termed as pulpefaction.
• Lacerations are usually seen underneath skull fractures.
• All penetrating injuries produce laceration of brain.
• Laceration may also be produced without fracture of skull,
when they are usually found in regions where the brain is in
contact with projecting buttresses and ridges on the inner
surface of the skull.
Coup and Contrecoup lesions:
• Coup injury(Blow impact): It means that the injury is located
beneath the area of impact and results directly by the
impacting force

• Contrecoup injury : It means that the lesion is present in an

area opposite to the side of impact.
Contrecoup injuries are rare before the age of three.
Mechanism:
• Contrecoup injury is caused when the moving head is
decelerated suddenly by hitting a firm surface, eg., striking
the head on the ground during the fall, usually seen in traffic
accidents ( deceleration injury).
• Occipital injuries produce severe and extensive contrecoup
lesions in the frontal region. The irregular bony prominences,
especially of the orbital and cribriform plates, and the lesser
wings of the sphenoid, contuse or lacerate the base of the
frontal lobes and the tips of the temporal lobes.
• A blow to the head produces a coup contusion, while
contrecoup contusions are either small or absent.
• A fall on the head produces contrecoup contusions, while
coup contusions are small or absent.
Concussion of the brain
• Definition : concussion is a state of temporary
unconsciousness (due to partial or complete paralysis of
cerebral function), due to head injury, comes on immediately
after injury, is always followed by amnesia, and tends to
spontaneous recovery.
• Mechanism : it occurs due to acceleration or deceleration of
the head. Cerebral concussion may be produced by direct
violence to the head, or by indirect violence as a result of
violent fall upon the feet or buttocks, by an unexpected fall on
the ground in traffic or industrial accidents.
• Severe injuries occur in coronal head motion only.
• Medicolegal importance – in case of head injury, if the patient becomes
unconscious, in between he may become conscious, which again
terminates into unconsciousness. These periods of consciousness are
labelled as lucid interval.

• The person is responsible for acts done(civil or criminal) during lucid interval.

• ( The period of sanity in an insane person is also called lucid interval).

• Diffuse axonal injury (DAI) is a brain injury in which

extensive lesions in white matter tracts occur over a widespread area. DAI
is the result of traumatic shearing forces that occur when the head is
rapidly accelerated or decelerated, as may occur in car accidents, falls,
and assaults.Vehicle accidents are the most frequent cause of DAI.

• Immediate disconnection of axons could be observed in severe brain

injury, but the major damage of DAI is delayed secondary axon
disconnections slowly developed over an extended time course
Punch-Drunk syndrome (traumatic
encephalopathy/dementia pugilistica)
• It refers to the chronic changes in the brain of a boxer, which
usually manifest after many episodes of minor head injuries.
• There will be deterioration in speed and coordination in boxers. In
extreme cases, it is recognised by slurred speech, memory loss,
stiff limbs and outbursts of violence.
Punch-Drunk Syndrome.
Cerebral oedema.
• Cerebral oedema occurs due to a localised or diffuse abnormal
accumulation of water and sodium, which increases the
volume of the brain.
• It is caused due to the increase in the intravascular pressure ,
increased permeability of the cerebral vessels, and decrease in
plasma colloid osmotic pressure.

• Focal oedema is almost invariably associated with and

secondary to contusions and lacerations of the brain. Focal
oedema in the brainstem is usually fatal.
• Generalised cerebral oedema occurs with diffuse brain injury.
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