Traumatic brain injury (TBI) is regarded as one of the most troubling forms of trauma, having in mind that about 50% of all survivors suffer from long-term physical, cognitive, emotional or behavioral sequelae [1]. Focal injuries of the brain occurring after interaction with the skull (most frequently with the inferior frontal lobes, frontal poles and the inferior temporal lobes) are known as contusions, which may be further complicated by herniation, hemorrhage, the formation of intracerebral hematomas, or laceration of the brain [2] [3]. Moreover, contusions are classified as coup or contrecoup lesions, suggesting whether the brain injury developed at the site of impact (coup) or at the opposite pole (contrecoup), often being more severe [2] [4]. Motor vehicle accidents are, by far, the most common cause of TBI and contusions, while blunt force trauma and sports activities are also important mechanisms of trauma [1] [4]. Regardless of the type of injury, the clinical presentation solely depends on its severity. Milder contusions usually do not cause any focal neurological deficits, while moderate and severe trauma can cause marked changes in the level of consciousness (lethargy, stupor, and coma are possible manifestations) and overall responsiveness of the patient [4] [5] [6]. One of the most important features of contusions is their frequent enlargement in the hours following the injury, leading to potentially severe and life-threatening neurological deterioration in the absence of an early diagnosis, suggesting that timely recognition of trauma and confirmation of a brain contusion is detrimental in order to achieve a good long-term outcome [5] [6].

A thorough diagnostic workup of all head traumas is absolutely necessary, starting with a detailed patient history that will identify the type, severity and exact site of injury. As patients can often present with altered consciousness, it is advised to obtain data from friends or family members, after which a thorough clinical examination is necessary. In all patients with suspected TBI, the GCS score must be calculated, composed of three components - verbal response, eye-opening, and motor function [3] [5]:

• Best verbal response - Patients may be oriented (5), confused (4), speak incomprehensible words (3), mumble (2) or do not have a response of any kind (1).
• Eye opening can occur spontaneously (4), only to speech (3) or pain (2), while most severe injuries cause a complete loss of this function (1).
• Obeying of commands ordered by the physician (6), a localized purposeful response after pain stimulation (5), withdrawal after pain stimuli, abnormal flexion (3) or extension (2) after pain or no response at all (1) are motor response categories of the GCS.

The importance of GCS lies in the assessment of further diagnostic steps and the prognosis, as patients with a lower GCS score (moderate TBI is scaled from 9-13, while severe TBI is assumed when GCS scores are 3-8) are at a much great risk for clinical deterioration and the development of complications. For this reason, immediate employment of imaging studies is vital [2] [4] [5]. Noncontrast computed tomography (CT) is recommended as first-line, as it is able to identify signs of hemorrhage in all parts of the brain, whereas magnetic resonance imaging (MRI), although limited in the acute setting because of its inability to recognize hemorrhagic lesions in the first several hours after trauma, is recommended for more complex injuries that require additional workup [2] [4] [5].

Treatment for a brain contusion depends on the severity of the injury. Mild contusions may only require observation and supportive care, such as pain management and rest. More severe cases may necessitate hospitalization, where the patient can be closely monitored for changes in neurological status. In some instances, surgical intervention may be required to relieve pressure on the brain or to remove large blood clots.

The prognosis for a brain contusion varies widely based on the severity of the injury and the patient's overall health. Mild contusions often resolve with minimal long-term effects, while severe contusions can lead to significant neurological deficits or even be life-threatening. Early intervention and appropriate management are crucial in improving outcomes.

Brain contusions are most commonly caused by blunt trauma to the head. This can occur during falls, motor vehicle accidents, sports injuries, or assaults. The force of impact causes the brain to collide with the inside of the skull, leading to bruising and bleeding. The severity of the contusion is influenced by the force and angle of the impact.

Brain contusions are a common form of traumatic brain injury, affecting individuals of all ages. However, they are more prevalent in young adults and the elderly, who are more susceptible to falls and accidents. Males are generally at a higher risk than females, largely due to higher rates of participation in high-risk activities.

The pathophysiology of a brain contusion involves the mechanical disruption of brain tissue and blood vessels due to impact. This leads to localized bleeding, swelling, and inflammation. The resulting increase in intracranial pressure can further damage brain tissue and impair neurological function. Secondary injury mechanisms, such as ischemia and excitotoxicity, may exacerbate the initial damage.

Preventing brain contusions involves minimizing the risk of head trauma. This can be achieved through the use of protective gear, such as helmets during sports and seat belts in vehicles. Additionally, implementing safety measures in the home and workplace, such as removing tripping hazards and using handrails, can reduce the risk of falls.

Brain contusions are a form of traumatic brain injury resulting from blunt force trauma to the head. They can cause a range of symptoms, from mild headaches to severe neurological deficits. Diagnosis typically involves imaging studies, and treatment varies based on the severity of the injury. While mild contusions often resolve with minimal intervention, severe cases may require surgical treatment. Prevention strategies focus on reducing the risk of head injuries through safety measures.

If you or someone you know has experienced a head injury, it is important to be aware of the symptoms of a brain contusion. These can include headaches, confusion, dizziness, and in severe cases, loss of consciousness or seizures. Early medical evaluation is crucial to determine the extent of the injury and to initiate appropriate treatment. Taking preventive measures, such as wearing helmets and using seat belts, can significantly reduce the risk of sustaining a brain contusion.

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2. Kim JJ, Gean AD. Imaging for the Diagnosis and Management of Traumatic Brain Injury. Neurotherapeutics. 2011;8(1):39-53.
3. MCKee AC, Daneshwar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol. 2015;127:45-66.
4. Lee B, Newberg A. Neuroimaging in Traumatic Brain Imaging. NeuroRx. 2005;2(2):372-383.
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
6. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.