Blunt Force Head Injury: Focal and Diffuse Injuries



The scalp and skull may be injured by contact injury. The presence of scalp bruising is indicative of contact injury and in some situations may provide clues to the possible intracranial pathology. Occipital bruising is typically associated with a backward fall and contrecoup contusions involving the frontal and temporal tips. Incised wounds are usually insignificant and easily managed in the emergency room, but in some cases they may be associated with blood loss, hypotension, and associated brain injury.

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Figure 2–2. Acute cortical contusions involving the inferior frontal lobes.On the left side, the contusions involve the full thickness of the cortex (black arrow), extending into underlying white matter. On the right side, there is more extensive tissue damage resulting in a laceration (white arrow).

Figure 2–3. Old cortical contusions involving the inferior aspect of the frontal lobes.The pathology is most obvious on the left-hand side of this image; the discoloration (arrow) is secondary to hemosiderin accumulation.

Figure 2–4. An acute extradural hematoma, revealed by removing the skull cap.The hematoma lies on the surface of the dura and is well circumscribed.

Figure 2–5. An acute subdural hematoma.The dura has been incised and reflected upward, revealing diffuse bleeding between the dura and the brain. The cut edges of the dura are highlighted by arrows.

Figure 2–6. Subfalcine herniation.The cingulate gyrus has been forced below the free edge of the falx cerebri, producing a notch (arrow). The herniated tissue shows the dusky discoloration of infarction.

Figure 2–7. Sections from different levels of the pons showing extensive hemorrhagic infarction within the brain stem secondary to axial displacement.This is commonly seen as a terminal event secondary to mass lesions, particularly extradural and subdural hematomas.

Figure 2–8. Medial occipital cortical infarction secondary to a tentorial hernia compressing the posterior cerebral artery.The right medial occipital cortex, involving the primary visual cortex, shows dusky discoloration. The area of infarction is outlined by arrows.

Figure 2–9. A wedge-shaped area of infarction involving the parahippocampal gyrus (arrow) is indicative of a previous episode of tentorial herniation.

Figure 2–10. In diffuse traumatic axonal injury, corpus callosal hemorrhage typically extends to involve the lateral white matter bundles (arrow).Hemorrhage secondary to infarction in cases with subfalcine herniation is more typically limited to the midline.

Figure 2–11. Eosinophilic axonal spheroids indicating axonal degeneration (arrows).Presence is not indicative of trauma as spheroids will also be seen secondary to a number of other pathologies, particularly ischemia (hematoxylin and eosin stain x40).

Figure 2–12. Degenerating axon (arrow) identified with beta-amyloid precursor protein (-APP) immunohistochemistry.The beaded appearance is typical in degenerating axons (β-APP immunohistochemistry x40).
Table Reference Number
Table 2–3. Causes of subdural hematoma (SDH)


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