OUTCOME OF CEREBRAL CONTUSIONS DUE TO TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI), also known as intracranial injury, is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a [1] projectile . Traumatic brain injury (TBI) is the most disabling of traumatic injuries often leading to lifelong physical, psychological, behavioral, [2,3] cognitive and emotional impairments .Nearly half of hospitalized survivors of TBI experience

CT scanning is an excellent modality for defining cerebral contusions and is the most preferred acute imaging modality, because it can be performed quickly and also in the presence of [8,9,10] life support equipment's . Contusions often are not appreciated on the first CT scan obtained immediately after trauma, but they become obvious on follow-up scans. The outcome of TBI depends on the cause and location of the injury. The outcome, severity and extent of neurological damage can range from a good recovery to death of the patient.
Surgery performed within first 24 hours has good results as compared to delayed surgery with much less hospital stay and mortality rate than those managed conservatively. Rate of contusion expansion and edema is also high in conservatively managed patients (Table-III).

RESULTS:
long term disabilities and constituting one of the largest expenditures in the Health Care System [4,5] .TBI encompass numerous types of insults to the brain, with one of the most severe being a hemorrhagic cerebral contusion. TBI associated with cerebral contusion is a frequent cause of [6] death & disability in trauma patients .Cerebral contusion is derived from a Latin word contusion cerebri meaning a bruise of the brain [7] tissue . Cerebral contusion, also known as brain Contusion occurs due to a bruise or injury to a region of the brain tissue. Contusions occur primarily in the cortical tissue, especially under the site of impact or in areas of brain located near sharp ridges on the inside of skull .It is commonly occur in coup or counter-coup injuries. In coup injuries, the brain is injured directly under the area of impact, while in counter-coup injuries it is injured on the opposite side of impact. Sign & symptoms of cerebral contusions depend upon the location, size and severity of the injury.
This study was conducted at the department of Neurosurgery Postgraduate Medical Institute Lahore General Hospital, Lahore from Jan 2012 to Dec 2014, with a total duration of two years. The study has been approved by the Ethical review committee of Postgraduate Medical Institute, Lahore General Hospital, Lahore. The patient's age ranges b/w 15-65 years and both sex were included in this study. A total 50 patients of cerebral contusions due to traumatic brain injury following road traffic accidents or history of falls confirmed on CT scan were included in our study. In our study 20 patients were managed conservatively while other 30 patients were operated for cerebral contusions. All patients with Contusions in Frontal, Parietal and Temporal regions having Volume of blood 20ml or more with GCS between (04 -12) were included in the study. Those with associated extradural haematoma (EDH), & intraventicular bleed, associated Skull fractures with age above 65 years and below 15 years were excluded from the study.
Total patients included in the study were 50. Among them, males were 41 (82%) and females were 09 (18%) with M: F ratio of 4: 1.
The youngest patient was of 15 years and the oldest was 64 years of age. The mean age was 38 years and the maximum numbers of patients were in third and fourth decades of life. Patients with GCS of (3-5), (6)(7)(8) and (9)(10)(11)(12) were managed both conservatively and surgically (

OUTCOME OF CEREBRAL CONTUSIONS SULTAN H., AZIZ A., et al.
Traumatic brain injury is the leading cause of mortality and morbidity in developing as well as [11] in most of the developed countries . Road traffic accidents are a major cause of cerebral contusions worldwide but especially in [12] developing and emerging countries . Cerebral parenchymal injury is evident in a considerable number of head injury victims. The most significant structural abnormality of the brain is contusion occurring in the brain parenchyma, which is a multifarious and dynamic area, due to primary lesion and is related to ischemic and i n fl a m m a t o r y p r o c e s s t h a t r e q u i r e s a c o m p r e h e n s i ve k n o w l e d g e a n d p r o p e r management plan. Cerebral contusions account for 25-30 % of severe head injuries and 8.5% of all traumatic brain injuries. In our study we present a review of important aspects of cerebral contusion, comparison of conservatively managed and surgically treated patients of cerebral contusions in head injury patients over a wide range of Glasgow Coma Scale between4 to 12. In our study of 50 patients, 41 were males and only 9 were females in whom 20 patients were managed conservatively while remaining 30 patients were operated from January 2012 to December 2014. The modes of injuries in our study were road traffic accidents and history of fall. In our study we managed patients with cerebral contusions in different lobes of the brain as shown in (table-II). Kawamata, et al conducted a study in Japan on 182 patients with cerebral contusions and proved that surgical excision provides satisfactory control of progressive elevation of ICP and clinical deterioration in [13] many cases .Becker, et al also advocated early evacuation of traumatic contusions for the [14] purpose of avoiding secondary complications . In our study we did early evacuation of cerebral contusions usually within first 24 hours by doing Craniotomy and Evacuation, Craniotomy with Lobectomy and also craniectomy in few cases for temporal contusions. These patients had better outcome, decreased hospital stay and less mortality as compared to those who were managed conservatively by doing initial resuscitation, head up and oxygen inhalation, mannitol infusion and anti-epileptic drug therapies.
It is concluded that early evacuation of cerebral contusion due to traumatic brain injury in patients with mild to moderate GCS improves neurological status of the patient, decreases mortality and hospital stay and abolishes the chance of contusion expansion.