WordNet

of or relating to the cerebrum or brain; "cerebral hemisphere"; "cerebral activity"
involving intelligence rather than emotions or instinct; "a cerebral approach to the problem"; "cerebral drama" (同)intellectual
the action of bruising; "the bruise resulted from a contusion"

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大脳の,脳の / 頭脳的な,知的な
打撲傷,打ち身 / 〈U〉打撲すること

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/03/30 13:06:31」(JST)

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Cerebral contusion, Latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue.^[2] Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries.^[3] A cerebral laceration is a similar injury except that, according to their respective definitions, the pia-arachnoid membranes are torn over the site of injury in laceration and are not torn in contusion.^[4]^[5] The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull.^[3] Thus treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull.

Contusions are likely to heal on their own without medical intervention.^[6]

Signs and symptoms

The symptoms of a cerebral contusion (bruising on the brain) depend on the severity of the injury, ranging from minor to severe. Individuals may experience a headache; confusion; sleepiness; dizziness; loss of consciousness; nausea and vomiting; seizures; and difficulty with coordination and movement; lightheadedness; tinnitus;spinning sensations. They may also have difficulty with memory, vision, speech, hearing, managing emotions, and thinking.^[7] Signs depend on the contusion's location in the brain.^[7]

Causes

The interior of the skull has sharp ridges by which a moving brain can be injured.

Often caused by a blow to the head, contusions commonly occur in coup or contre-coup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact.

Contusions occur primarily in the cortical tissue, especially under the site of impact or in areas of the brain located near sharp ridges on the inside of the skull. The brain may be contused when it collides with bony protuberances on the inside surface of the skull.^[8] The protuberances are located on the inside of the skull under the frontal and temporal lobes and on the roof of the ocular orbit.^[9] Thus, the tips of the frontal and temporal lobes located near the bony ridges in the skull are areas where contusions frequently occur and are most severe.^[10] For this reason, attention, emotional and memory problems, which are associated with damage to frontal and temporal lobes, are much more common in head trauma survivors than are syndromes associated with damage to other areas of the brain.^[11]

Features

Contusions, which are frequently associated with edema, are especially likely to cause increases in intracranial pressure (ICP) and concomitant crushing of delicate brain tissue.

Contusions typically form in a wedge-shape with the widest part in the outermost part of the brain.^[12]

The distinction between contusion and intracerebral hemorrhage is blurry because both involve bleeding within the brain tissue; however, an arbitrary cutoff exists that the injury is a contusion if two thirds or less of the tissue involved is blood and a hemorrhage otherwise.^[3]

The contusion may cause swelling of the surrounding brain tissue, which may be irritated by toxins released in the contusion.^[3] The swelling is worst at around four to six days after the injury.^[3]

Extensive contusion associated with subdural hematoma is called burst lobe.^[5] Cases of a burst frontal or temporal lobe are associated with high mortality and morbidity.^[5]

Old or remote contusions are associated with resorption of the injured tissue, resulting in various degrees of cavitation, in addition to the presence of a golden-yellow discoloration due to residual hemosiderin. These remote contusions are often referred to as plaque jaune or yellow plaque.^[13]

Multiple petechial hemorrhages

Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhages or multifocal hemorrhagic contusion.^[14] Caused by shearing injuries at the time of impact, these contusions occur especially at the junction between grey and white matter and in the upper brain stem, basal ganglia, thalamus and areas near the third ventricle.^[14] The hemorrhages can occur as the result of brain herniation, which can cause arteries to tear and bleed.^[14] A type of diffuse brain injury, multiple petechial hemorrhages are not always visible using current imaging techniques like CT and MRI scans. This may be the case even if the injury is quite severe, though these may show up days after the injury.^[15] Hemorrhages may be larger than in normal contusions if the injury is quite severe. This type of injury has a poor prognosis if the patient is comatose, even with no apparent causes for the coma.^[15]

Treatment

MRI showing damage due to herniation in a patient who had had contusions in the frontal lobes.^[1]

Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of hypotension (low blood pressure), hyponatremia (insufficient sodium), and hypercapnia (increased carbon dioxide in the blood).^[3] Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it.^[3] People with cerebral contusion may require intensive care and close monitoring.^[3]

References

^ ^a ^b Rehman T, Ali R, Tawil I, Yonas H (2008). "Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report". Cases Journal. 1 (1): 203. doi:10.1186/1757-1626-1-203. PMC 2566562. PMID 18831756.
^ Hardman JM, Manoukian A (2002). "Pathology of Head Trauma". Neuroimaging Clinics of North America. 12 (2): 175–187, vii. doi:10.1016/S1052-5149(02)00009-6. PMID 12391630.
^ ^a ^b ^c ^d ^e ^f ^g ^h Khoshyomn S, Tranmer BI (May 2004). "Diagnosis and management of pediatric closed head injury". Seminars in Pediatric Surgery. 13 (2): 80–86. doi:10.1053/j.sempedsurg.2004.01.003. PMID 15362277.
^ Granacher RP (2007). Traumatic Brain Injury: Methods for Clinical & Forensic Neuropsychiatric Assessment (Second ed.). Boca Raton: CRC. p. 26. ISBN 0-8493-8138-X. Retrieved 2008-07-06.
^ ^a ^b ^c Gennarelli GA, Graham DI (2005). "Neuropathology". In Silver JM, McAllister TW, Yudofsky SC. Textbook Of Traumatic Brain Injury. Washington, DC: American Psychiatric Association. p. 29. ISBN 1-58562-105-6. Retrieved 2008-06-10.
^ Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.
^ ^a ^b Kushner D (1998). "Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment". Archives of Internal Medicine. 158 (15): 1617–1624. doi:10.1001/archinte.158.15.1617. PMID 9701095.
^ Rao V, Lyketsos C (2000). "Neuropsychiatric Sequelae of Traumatic Brain Injury". Psychosomatics. 41 (2): 95–103. doi:10.1176/appi.psy.41.2.95. PMID 10749946.
^ Shepherd S. 2004. "Head Trauma." Emedicine.com. Retrieved on 2008-01-10.
^ Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
^ Bigler, ED. 2000. The Lesion(s) in Traumatic Brain Injury: Implications for Clinical Neuropsychology. Accessed through web archive. Retrieved on 2008-01-17.
^ Vinas FC and Pilitsis J. 2006. "Penetrating Head Trauma." Emedicine.com. Retrieved on 2008-01-10.
^ http://kobiljak.msu.edu/CAI/Pathology/Trauma_F/Trauma_3.html
^ ^a ^b ^c "Brain Injury, Traumatic". Medcyclopaedia. GE. Archived from the original on 2011-05-26.
^ ^a ^b Downie A. 2001. "Tutorial: CT in Head Trauma" Archived 2005-11-06 at the Wayback Machine. Retrieved May 8, 2008

External links

UpToDate Contents

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English Journal

MADYMO simulation of children in cycle accidents: A novel approach in risk assessment.

McNally DS, Rosenberg NM.SourceFaculty of Engineering, University of Nottingham, University Park, Nottingham NG7 2RD, UK. Electronic address: donal.mcnally@nottingham.ac.uk.
Accident; analysis and prevention.Accid Anal Prev.2013 Oct;59:469-78. doi: 10.1016/j.aap.2013.07.022. Epub 2013 Jul 24.
Head injuries are a significant cause of death and injury to child cyclists both on and off the road. Current evaluations of the effectiveness of cycle helmets rely on simplified mechanical testing or the analysis of aggregated accident statistics. This paper presents a direct evaluation of helmet e
PMID 23954681

A Randomized Controlled Pilot Trial of Modified Whole Blood versus Component Therapy in Severely Injured Patients Requiring Large Volume Transfusions.

Cotton BA, Podbielski J, Camp E, Welch T, Del Junco D, Bai Y, Hobbs R, Scroggins J, Hartwell B, Kozar RA, Wade CE, Holcomb JB.SourceDepartments of *Surgery, †Center for Translational Injury Research, and ‡Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, TX; and §Gulf Coast Regional Blood Center, Houston, TX.
Annals of surgery.Ann Surg.2013 Oct;258(4):527-33. doi: 10.1097/SLA.0b013e3182a4ffa0.
OBJECTIVES: To determine whether resuscitation of severely injured patients with modified whole blood (mWB) resulted in fewer overall transfusions compared with component (COMP) therapy.BACKGROUND: For decades, whole blood (WB) was the primary product for resuscitating patients in hemorrhagic shock.
PMID 23979267

Effects of selective hypothermia on blood-brain barrier integrity and tight junction protein expression levels after intracerebral hemorrhage in rats.

Sun H, Tang Y, Guan X, Li L, Wang D.AbstractAbstract Hypothermia has neuroprotective effects on global cerebral ischemic injuries. However, its efficacy after intracerebral hemorrhage (ICH) is inconclusive. In this study, bacterial collagenase was used to induce ICH stroke in male Wistar rats. We assessed the effects of normothermia and 4 h of local hypothermia (∼33.2°C) initiated 1, 6, or 12 h after collagenase infusion on hemorrhage volume and neurological outcomes. Following early cooling initiated after 1 h, blood-brain barrier (BBB) disruption and brain water content were tested. Furthermore, the expression levels of tight junction (TJ) proteins (claudin 5 and occludin) and the proinflammatory cytokines interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) were determined using Western blotting, real-time quantitative PCR, and immunohistochemical staining at 1 and 3 d after ICH. Early local hypothermia tends to reduce hemorrhagic volume and neurological deficits, but the difference is not statistically significant compared with other groups. However, early hypothermia significantly reduces BBB disruption, edema formation, the expression levels of IL-1β and TNF-α, and the loss of TJ proteins. Together, these data suggest that local hypothermia is an effective treatment for edema formation and BBB disruption via the upregulation of TJ proteins and the suppression of TNF-α and IL-1β.
Biological chemistry.Biol Chem.2013 Oct 1;394(10):1317-24. doi: 10.1515/hsz-2013-0142.
Abstract Hypothermia has neuroprotective effects on global cerebral ischemic injuries. However, its efficacy after intracerebral hemorrhage (ICH) is inconclusive. In this study, bacterial collagenase was used to induce ICH stroke in male Wistar rats. We assessed the effects of normothermia and 4 h o
PMID 23828426

Japanese Journal

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大渕英徳,萩原信司,菊池麻美 [他],高橋祐一,吉村知香,横佐古卓,新井直幸,黒井康博,広田健吾,笹原篤,谷茂,糟谷英俊
東京女子医科大学雑誌 84(1), 9-12, 2014-02-25
(はじめに)頭部外傷において、短時間の間に両側の血腫除去術を要する例は稀である。今回我々は受傷後12時間以内に両側の血腫除去術を行った頭部外傷8症例について臨床的検討を行った。(対象)過去10年間に女子医大東医療センターで外傷性頭蓋内血腫除去術を行った168症例のうち、受傷後12時間以内に両側の頭蓋内血腫除去術を行なった8症例(4.8%)を対象とした。(結果)症例の内訳は男性4例、女性4例。受傷機 …
NAID 110009676512

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脳循環代謝（日本脳循環代謝学会機関誌） 25(2), 63-66, 2014
頭部外傷に伴う脳組織の変性と再生を予測することは困難であり，このことが適切な治療方法の選択を困難にしている．頭部外傷の基礎研究が進展しない原因の一つとして，臨床を適切に反映した動物モデルがないことが挙げられる．ヒトでは頭蓋を破壊しない程度の物理的衝撃であっても脳挫傷を引き起こしうるが，これをげっ歯類などにおいて再現することは困難である．従来の頭部外傷モデルは，頭蓋を除去して露出させた脳実質に物理的 …
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無輸血にて治療した維持透析中の多発外傷患者の1例

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日本救急医学会雑誌 25(5), 208-214, 2014
症例は60歳の男性。慢性腎不全のため維持透析を週に3回行っていた。横断歩道を歩行中乗用車にはねられ，胸骨骨折，左多発肋骨骨折，両側血胸，両側肺挫傷，右気胸，顔面骨骨折，両側下顎骨骨折，骨盤骨折，第2，3腰椎右横突起骨折，右腓骨近位端骨折，左橈骨遠位端骨折を受傷した。ISSは29であった。出血性ショックとなったが，宗教上の理由により本人および家族が輸血（全血，赤血球，白血球，血小板，血漿）を明確に拒 …
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★リンクテーブル★

リンク元	「brain contusion」「脳挫傷」
関連記事	「cerebral」「contusion」

「brain contusion」

Cerebral contusion
	CT scan showing cerebral contusions, hemorrhage within the hemispheres, subdural hematoma on the left, and skull fractures
Specialty	Emergency medicine

　　[★] 脳挫傷

関: acute brain injury、brain injury、brain trauma、cerebral contusion、cortical contusion、diffuse brain injury、focal brain injury、TBI、traumatic brain injury、traumatic encephalopathy

「脳挫傷」

　　[★]

英: cerebral contusion, brain contusion
ラ: contusio cerebri
関: 対側打撃

「cerebral」

　　[★]

adj.

大脳の、大脳性の、脳性の、脳の

関: brain、cerebri、cerebro、cerebrum、encephalic、encephalo、encephalon

「contusion」

　　[★]

n.

打撲傷、挫創

[Rehman08-1] Rehman T, Ali R, Tawil I, Yonas H (2008). "Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report". Cases Journal. 1 (1): 203. doi:10.1186/1757-1626-1-203. PMC 2566562. PMID 18831756.

[Hardman02-2] Hardman JM, Manoukian A (2002). "Pathology of Head Trauma". Neuroimaging Clinics of North America. 12 (2): 175–187, vii. doi:10.1016/S1052-5149(02)00009-6. PMID 12391630.

[Khoshyomn04-3] ^ ^a ^b ^c ^d ^e ^f ^g ^h Khoshyomn S, Tranmer BI (May 2004). "Diagnosis and management of pediatric closed head injury". Seminars in Pediatric Surgery. 13 (2): 80–86. doi:10.1053/j.sempedsurg.2004.01.003. PMID 15362277.

[Granacher07-4] Granacher RP (2007). Traumatic Brain Injury: Methods for Clinical & Forensic Neuropsychiatric Assessment (Second ed.). Boca Raton: CRC. p. 26. ISBN 0-8493-8138-X. Retrieved 2008-07-06.

[Gennarelli04-5] Gennarelli GA, Graham DI (2005). "Neuropathology". In Silver JM, McAllister TW, Yudofsky SC. Textbook Of Traumatic Brain Injury. Washington, DC: American Psychiatric Association. p. 29. ISBN 1-58562-105-6. Retrieved 2008-06-10.

[6] Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.

[Kushner98-7] Kushner D (1998). "Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment". Archives of Internal Medicine. 158 (15): 1617–1624. doi:10.1001/archinte.158.15.1617. PMID 9701095.

[RaoLyketsos-8] Rao V, Lyketsos C (2000). "Neuropsychiatric Sequelae of Traumatic Brain Injury". Psychosomatics. 41 (2): 95–103. doi:10.1176/appi.psy.41.2.95. PMID 10749946.

[Shepherd-9] Shepherd S. 2004. "Head Trauma." Emedicine.com. Retrieved on 2008-01-10.

[10] Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.

[Bigler-11] Bigler, ED. 2000. The Lesion(s) in Traumatic Brain Injury: Implications for Clinical Neuropsychology. Accessed through web archive. Retrieved on 2008-01-17.

[Vinas_and_Pilistis-12] Vinas FC and Pilitsis J. 2006. "Penetrating Head Trauma." Emedicine.com. Retrieved on 2008-01-10.

[13] ttp://kobiljak.msu.edu/CAI/Pathology/Trauma_F/Trauma_3.html

[GE_Healthcare-14] "Brain Injury, Traumatic". Medcyclopaedia. GE. Archived from the original on 2011-05-26.

[Downie-15] Downie A. 2001. "Tutorial: CT in Head Trauma" Archived 2005-11-06 at the Wayback Machine. Retrieved May 8, 2008

v t e Neurotrauma (S06, Sx4, T09.3–4, 850–854, 950–957)
Traumatic brain injury	Intracranial hemorrhage Intra-axial Intraparenchymal hemorrhage Intraventricular hemorrhage Extra-axial Subdural hematoma Epidural hematoma Subarachnoid hemorrhage Brain herniation Cerebral contusion Cerebral laceration Concussion Post-concussion syndrome Second-impact syndrome Dementia pugilistica Chronic traumatic encephalopathy Diffuse axonal injury Abusive head trauma Penetrating head injury
Spinal cord injury	Anterior spinal artery syndrome Brown-Séquard syndrome Cauda equina syndrome Central cord syndrome Paraplegia Posterior cord syndrome Spinal cord injury without radiographic abnormality Tetraplegia (Quadriplegia)
Peripheral nerves	Nerve injury Peripheral nerve injury classification Wallerian degeneration Injury of accessory nerve Brachial plexus injury Traumatic neuroma

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cerebral contusion