Traumatic subarachnoid hemorrhage: coup-contrecoup pattern

Case contributed by Dr Henry Knipe


Fall from standing height.

Patient Data

Age: 80
Gender: Female

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


Subarachnoid hemorrhage in a traumatic coup-contrecoup pattern.

Thin left tentorium cerebelli subdural hematoma.

  • blue arrow = direction of force
  • yellow arrow = subarachnoid hemorrhage and subgalael hematoma (coup injury, i.e. site of impact)
  • red arrow = subarachnoid hemorrhage (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
Published: 29th Jan 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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