Neurocritical Care

, Volume 1, Issue 3, pp 385–390 | Cite as

The contrecoup-coup phenomenon

A new understanding of the mechanism of closed head injury
New Perspectives In Brain Injury

Abstract

A common observation in closed head injuries is the contrecoup brain injury. As the in vivo brain is less dense than the cerebrospinal fluid (CSF), one hypothesis explaining this observation is that upon skull impact, the denser CSF moves toward the site of skull impact displacing the brain in the opposite direction, such that the initial impact of the brain parenchyma is at the contrecoup location.

A simple model was developed consisting of a balloon filled with water of density 1.00 g/mL enclosed in a clear plastic jar containing salt water of density 1.04 g/mL, simulating the same relative densities of the CSF and brain. The initial movement of the balloon, modeling the brain, was toward the contrecoup location with subsequent movement toward the coup location.

The pattern of brain injury in which the contrecoup injury is greater than the coup injury is a result of initial movement of the brain in the contrecoup location.

During the process of closed head injury, the brain parenchyma is initially displaced away from the site of skull impact and toward the contrecoup site resulting in the more severe brain contusion.

Key Words

Biomechanics traumatic brain injury pathology contrecoup lesion 

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References

  1. 1.
    Knight B. Head and spinal injuries. In: Forensic Pathology. Internet, http://www2.kobe-u.ac.jp/∼yanagida/Pathology.htm.Google Scholar
  2. 2.
    Vinken PJ, Bruyn GW, Klawans HL. Head injury, vol. 57. Elsevier, New York, 1990Google Scholar
  3. 3.
    Graham DI, Lantos PL. Greenfield’s neuropathology, 7th ed. Arnold, London, UK, 2002.Google Scholar
  4. 4.
    Dawson SL, Hirsch CS, Lucas FV, Sebek BA. The contrecoup phenomenon, reappraisal of a classic problem. Hum Pathol 1980;11:155–166.PubMedGoogle Scholar
  5. 5.
    Gurdjian ES, Gurdjian ES. Cerebral contusions: reappraisal of the mechanism of their development. J Trauma 1976;16:35–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindenberg R. Mechanical injuries of brain and meninges. In: Medicolegal investigation of death (Spitz WU, Fisher RS, ed.).. Charles C. Thomas, Spingfield, IL, 1973.Google Scholar
  7. 7.
    Lindenberg R. Trauma of meninges and brain. In: Pathology of the nervous system (Minckler J, ed.).. McGraw-Hill, New York, 1971.Google Scholar
  8. 8.
    Lindenberg R, Freytag E. The mechanism of cerebral contusions. Arch Path 1960;69:440.PubMedGoogle Scholar
  9. 9.
    Guyton AC, Hall JE. Textbook of medical physiology, 10th ed., W.B. Saunders, Philadelphia, 2000.Google Scholar
  10. 10.
    Holbourn AH. Mechanics of head injuries. Lancet 1943;2:438.CrossRefGoogle Scholar
  11. 11.
    Holbourn AH. The mechanics of brain injuries. Brit Med Bull 1945;3:147.Google Scholar
  12. 12.
    Huang HM, Lee MC. Finite element analysis of brain contusion: an indirect impact study. Med Biol Eng Comput 2000;38:253–259.PubMedCrossRefGoogle Scholar
  13. 13.
    Halliday D, Resnick R. Fundamentals of physics. John Wiley and Sons, New York, 1970.Google Scholar
  14. 14.
    Gurdjian ES, Lissner HR, Patrick LM. Protection of the head and neck in sports. JAMA 1962; 182:509.PubMedGoogle Scholar
  15. 15.
    Gurdjian ES, Hogdson VR, Thomas LM, Patrick LM. Impact head injury—mechanisms and prevention. GP 1968;37:78–87.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2004

Authors and Affiliations

  1. 1.Wright-Patterson Medical CenterWright-Patterson AFB
  2. 2.Oakwood High SchoolDayton

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