Traumatic subarachnoid haemorrhage: coup-contrecoup pattern

Case contributed by Dr Henry Knipe

Presentation

Fall from standing height.

Patient Data

Age: 80
Gender: Female

Subarachnoid haemorrhage in a left frontoparietal and right temporo-parieto-occipital distribution. Small volume of haemorrhage in the basal cisterns. Left tentorium cerebelli subdural haematoma measuring up to 3 mm. Ventricles, sulcal pattern and basal cisterns are age-appropriate. No skull fracture. Large left frontal subcutaneous haematoma.

Conclusion:

Subarachnoid haemorrhage in a traumatic coup-contrecoup pattern.

Thin left tentorium cerebelli subdural haematoma.

  • blue arrow = direction of force
  • yellow arrow = subarachnoid haemorrhage and subgalael haematoma (coup injury, i.e. site of impact)
  • red arrow = subarachnoid haemorrhage (contrecoup injury)

Case Discussion

Subsequent investigations did not reveal an aneurysmal cause. Coup-contrecoup injury patterns are common after a direct blow to the cranium. 

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Case information

rID: 33934
Case created: 29th Jan 2015
Last edited: 7th Sep 2015
Inclusion in quiz mode: Included

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