Coup contrecoup injury

Background

• Type of TBI
• Coup: injury site on the side of the blunt force mechanism
• Contrecoup: opposing side injury from movement of the brain and cerebral spinal fluid shift from translational forces

Clinical Presentation

• TBI like symptoms
• Headache
• Visionary discomfort
• Nausea and Vomiting
• Dizziness
• Fatigue
• Uneven gait

Differential Diagnosis

• Concussion
• Skull Fracture

Intracranial Hemorrhage Types

• Intra-axial
  • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  • Traumatic intracerebral hemorrhage
• Extra-axial
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)

Labs and Imaging

• ETOH level

• Drug Use
• Trauma Labs depending on history (or lack there of)

Management

• ACEP Clinical Policy (2008)
• Assess for additional injuries
• Pain Control
• Neurosurgery Consult
• Trauma Consult

Disposition

• Often kept for observation
• Home if at baseline, no additional injuries
  • Inform about post-concussive symptoms
• Outpatient Concussion Clinic/Head Trauma Clinic

Also See

• Concussion
• Head CT in Trauma (Clinical Decision Rules)
• Head CT interpretation
• EBQ:Canadian Head CT Rule