Coup contrecoup injury

Background

When the head strikes a fixed object, the coup injury occurs at the site of impact and the contrecoup injury occurs at the opposite side.

• 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 Features

• TBI like symptoms
• Headache
• Visionary discomfort
• Nausea/vomiting
• Dizziness
• Fatigue
• Uneven gait

Differential Diagnosis

• Concussion
• Skull Fracture

Intracranial Hemorrhage Types

• Intra-axial
  • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  • Traumatic intracerebral hemorrhage
• Extra-axial
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)

Evaluation

Labs and Imaging

• Trauma Labs depending on history (or lack there of)

Management

• Assess for additional injuries
• Analgesia
• Consider neurosurgery, trauma consult depending on degree of injury

Disposition

• Often kept for observation
• Home if at baseline, no additional injuries
  • Inform about post-concussive symptoms
• Outpatient concussion/head trauma clinic if available

Also See

• Concussion
• Head CT in Trauma (Clinical Decision Rules)
• Head CT interpretation
• EBQ:Canadian Head CT Rule