Presentation
Sustained a fall. Right occipito-parietal soft tissue wound. Recent history of prior left frontobasal traumatic contusion bleeding and occipital skull base fracture.
Patient Data
right occipito-parietal soft tissue swelling and hematoma
new right parietal undisplaced fracture which joins the known prior occipital fracture through the lambdoid suture
subtle subdural bleeding adjacent to the fracture line on the right close to the foramen magnum
left temporal small contusions and acute subdural hematoma, position in keeping with contrecoup injury mechanism
status post prior left frontobasal contusion
Case Discussion
The coup-contrecoup injury pattern also doubles as a search pattern. In direct head trauma whenever possible obtain the site of impact (soft tissue injury is only visible in substantial minority) of cases. Absence of an unequivocal coup injury unfortunately does not rule out the possibility of a contre coup per se.
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