Coup contrecoup injury

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When the head strikes a fixed object, the coup injury occurs at the site of impact and the contrecoup injury occurs at the opposite side.

In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was impacted.[1] Coup and contrecoup injuries are associated with cerebral contusions,[2] a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical,[3] while contrecoup injuries are produced when the moving head strikes a stationary object.[1]

Coup and contrecoup injuries are considered focal brain injuries, those that occur in a particular spot in the brain, as opposed to diffuse injuries, which occur over a more widespread area.[4]

The exact mechanism for the injuries, especially contrecoup injuries, is a subject of much debate.[5] In general, they involve an abrupt deceleration of the head, causing the brain to collide with the inside of the skull. It is likely that inertia is involved in the injuries, e.g. when the brain keeps moving after the skull is stopped by a fixed object or when the brain remains still after the skull is accelerated by an impact with a moving object.[5] Additionally, movement of cerebrospinal fluid following a trauma may play a role in the injury.[5]

Mechanisms

Coup injury may be caused when, during an impact, the skull is temporarily bent inward and impacts the brain.[6] When the skull bends inward, it may set the brain into motion, causing it to collide with the opposite side of the skull; this will result in a contrecoup injury.[7] The injuries can also be caused solely by acceleration or deceleration, in the absence of an impact.[4] In injuries associated with acceleration or deceleration but with no impact, the brain is thought to bounce off the inside of the skull and hit the opposite side, potentially resulting in both coup and contrecoup injuries.[7] In addition to the skull, the brain may also impact the tentorium, causing a coup injury.[8] Contrecoup injury may be produced by tensile forces.[9]

Cerebrospinal fluid (CSF) is also implicated in the mechanism of coup and contrecoup injuries.[10] One explanation for the contrecoup phenomenon is that CSF, which is denser than the brain, rushes to the area of impact during the injury, forcing the brain back into the other side of the skull. If this is the case, the contrecoup impact happens first.[11]

Features

Contrecoup, which may occur in shaken baby syndrome and vehicle accidents, can cause diffuse axonal injury.[12] On very rare occasions, contrecoup injury can cause epidural hematoma.[13]

Contrecoup contusions are particularly common in the lower part of the frontal lobes and the front part of the temporal lobes.[4] A 1978 study found that the contrecoup mechanism was responsible for most of the brain lesions such as contusions and hematomas occurring in the temporal lobes of injured individuals.[14] Injuries that occur in body parts other than the brain, such as the lens of the eye,[2] the lung,[15] and the skull[16] and other bones, may also be labelled "contrecoup". The contrecoup mechanism can play a role in pulmonary contusion.[17]

History

In the 17th century, Jean Louis Petit described contrecoup injuries.[18] In 1766, the French surgeon Antoine Louis coordinated a meeting of the Académie Royale de Chirurgie on contrecoup injuries, at which papers were to be presented, one of which would be chosen to receive the respected prize, the Prix de l'Académie Royale de Chirurgie. The presenter of the chosen paper was not awarded the prize because he failed to make recommended changes. In 1768, the group met again on the topic, and Louis Sebastian Saucerotte won the prize for his paper describing contrecoup injuries in humans and experiments on animals and recommending treatments such as bloodletting and application of herbs to patients' heads.[19]

In popular culture

Contrecoup is the subject of a They Might Be Giants song off their album The Else. It was written as a challenge to create a song using the words contrecoup, craniosophic, and limerent.

In Meld (Star Trek: Voyager), the ship's doctor is able to use the distinction between coup injury and contrecoup injury to determine that a dead crewman was murdered.

References

  1. ↑ 1.0 1.1 Poirier MP (2003). "Concussions: Assessment, management, and recommendations for return to activity (abstract)". Clinical Pediatric Emergency Medicine 4 (3): 179–185. doi:10.1016/S1522-8401(03)00061-2. 
  2. ↑ 2.0 2.1 Lury K, Castillo M (2004). "Lens dislocation: An unusual form of contrecoup injury". American Journal of Roentgenology 183 (1): 250–251. doi:10.2214/ajr.183.1.1830250. PMID 15208154. 
  3. ↑ Morrison AL, King TM, Korell MA, Smialek JE, Troncoso JC (1998). "Acceleration-deceleration injuries to the brain in blunt force trauma". American Journal of Forensic Medical Pathology 19 (2): 109–112. doi:10.1097/00000433-199806000-00002. PMID 9662103. 
  4. ↑ 4.0 4.1 4.2 Hardman JM, Manoukian A (2002). "Pathology of head trauma". Neuroimaging Clinics of North America 12 (2): 175–187, vii. doi:10.1016/S1052-5149(02)00009-6. PMID 12391630. 
  5. ↑ 5.0 5.1 5.2 Shaw NA (2002). "The neurophysiology of concussion". Progress in Neurobiology 67 (4): 281–344. doi:10.1016/S0301-0082(02)00018-7. PMID 12207973. 
  6. ↑ Gurdjian ES; Gurdjian, Edwin S. (1976). "Cerebral contusions: Re-evaluation of the mechanism of their development". Journal of Trauma 16 (1): 35–51. doi:10.1097/00005373-197601000-00005. PMID 1246097. 
  7. ↑ 7.0 7.1 Gengenbach MS, Hyde T (2007). Conservative Management of Sports Injuries. Sudbury, Massachusetts: Jones & Bartlett Publishers. p. 316. ISBN 0-7637-3252-4. 
  8. ↑ Saeki N, Higuchi Y, Sunami K, Yamaura A (2000). "Selective hemihypaesthesia due to tentorial coup injury against dorsolateral midbrain: potential cause of sensory impairment after closed head injury [http://jnnp.bmj.com/cgi/content/full/68/1/117 (requires free registration)]". Journal of Neurology, Neurosurgery, and Psychiatry 68 (1): 117–118. doi:10.1136/jnnp.68.1.117. PMC 1760598. PMID 10671129. 
  9. ↑ Bernhardt DT (December 18, 2007). "Concussion". eMedicine.com. Retrieved 2008-01-14. 
  10. ↑ Qureshi NH (February 1, 2008). "Skull Fracture". eMedicine. Retrieved 2008-02-11. 
  11. ↑ Drew LB, Drew WE (2004). "The contrecoup-coup phenomenon: a new understanding of the mechanism of closed head injury". Neurocritical Care 1 (3): 385–390. doi:10.1385/NCC:1:3:385. PMID 16174940. 
  12. ↑ NINDS. "Traumatic Brain Injury: Hope Through Research". National Institute of Neurological Disorders and Stroke. Retrieved 2008-01-25. 
  13. ↑ Mishra A, Mohanty S (2001). "Contre-coup extradural haematoma : A short report". Neurology India 49 (94): 94–5. PMID 11303253. 
  14. ↑ Tandon PN, Prakash B, Banerji AK (1978). "Temporal lobe lesions in head injury". Acta Neurochirgica 41 (1–3): 205–221. doi:10.1007/BF01809150. PMID 665331. 
  15. ↑ Katoh T, Hirakata Y, Kobayashi J, Sugiyama Y, Kitamura S, Hirota N (1996). "Contralateral Lung Contusion". Nihon Kyobu Shikkan Gakkai Zasshi (in Japanese) 34 (9): 993–996. PMID 8937144. 
  16. ↑ Gennarelli GA, Graham DI (2005). "Neuropathology". In Silver JM, McAllister TW, Yudofsky SC. Textbook Of Traumatic Brain Injury. Washington, DC: American Psychiatric Association. p. 29. ISBN 1-58562-105-6. Retrieved 2008-06-10. 
  17. ↑ Sattler S, Maier RV (2002). "Pulmonary contusion". In Karmy-Jones R, Nathens A, Stern EJ. Thoracic Trauma and Critical Care. Berlin: Springer. pp. 159–160 and 235–243. ISBN 1-4020-7215-5. Retrieved 2008-04-22. 
  18. ↑ Masferrer R, Masferrer M, Prendergast V, Harrington TR (2000). "Grading Scale for Cerebral Concussions". BNI Quarterly (Barrow Neurological Institute) 16 (1). ISSN 0894-5799. 
  19. ↑ Finger S (2001). Origins of Neuroscience: A History of Explorations into Brain Function. Oxford [Oxfordshire]: Oxford University Press. pp. 429–430. ISBN 0-19-514694-8. 
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