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
DDX
- Concussion
- ===Intracranial Hemorrhage Types===
- Intra-axial
- Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
- Traumatic intracerebral hemorrhage
- Extra-axial
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
- Skull Fracture
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