Coup-contrecoup contusion hemorrhages

Case contributed by Dr Bálint Botz

Presentation

Sustained a fall. Resultant large left parietal soft tissue hematoma. Alert, no focal neurological deficit upon examination. IC bleeding?

Patient Data

Age: 90 years
Gender: Female
  • Large left parieto-occipital subcutaneous and subgaleal hematoma indicates the site of impact.
  • Adjacent small parietal cortical hyperdensity represents the resultant contusion bleeding (coup).
  • Along the oblique trajectory of the impact force, a similar cortical contusion is visible in the contralateral temporal lobe (contrecoup). 
  • No associated bony injury, 

Case Discussion

A classic example of coup-contrecoup injury pattern. Heuristic search pattern putting the site of impact and the trajectory of shearing force in consideration facilitates prompt diagnosis. 

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