Contrecoup Traumatic Intracerebral Hemorrhage: A Geometric Study of the Impact Site and Association with Hemorrhagic Progression

Address correspondence to: Santiago Cepeda, MD, Department of Neurosurgery, Hospital 12 de Octubre, Avda de Cordoba s/n, Madrid 28041, Spain, E-mail: [email protected]

Introduction

Traumatic intracerebral hemorrhage (TICH) represents approximately 13-48% of lesions after a traumatic brain injury (TBI).^1-3 The frequency of TICH-hemorrhagic progression (TICH-HP) is estimated to be approximately 38-63%, according to previously published series.^3-10 This potential risk of progression determines a worse outcome for the patients.^9,11,12

The contrecoup phenomenon has been a matter of discussion for many decades. Several theories explaining the mechanism of production of TICH have been postulated.^13-17 The relationship between the site of impact and TICH location has been widely described in autopsy-based series. This association, however, has not been consistently demonstrated since the introduction of computed tomography (CT) in the study of TBI. Only a few studies in the literature are based on CT scans to study the frequency of contrecoup TICH.^18,19

The primary objective of our study was to determine the association between the impact site and TICH location in patients with moderate and severe TBI. At the same time, the frequency and location of the contrecoup TICH were determined.

As a secondary objective, we analyzed the associations between TICH location, the impact site, the mechanism of production (coup or contrecoup), and TICH-HP.

Methods

Inclusion and exclusion criteria

We retrospectively analyzed the records of 408 patients older than 15 years of age who were consecutively admitted after having a closed (nonmissile) moderate or severe TBI, which was defined as a score of 3 to 13 points on the Glasgow Coma Scale (GCS) after nonsurgical resuscitation within the first 48 h after trauma, between January 2010 and November 2014 at University...