Brain Contusions

What Is a Brain Contusion?

Brain, or cerebral, contusions are brain injuries caused by a blow to the head, with the degree of injury related to the force of the blow. Bleeding occurs under the brain’s protective lining, and spreading occurs in up to 75% of brain contusions.

Immediate treatment is needed to prevent spreading and to prevent blood from pooling on the brain tissue, which can be toxic to brain cells.

What Are the Signs or Symptoms of a Brain Contusion?

The most common symptoms of a brain contusion are:

• Headaches
• Nausea
• Vomiting
• Dizziness
• Ringing in the ears
• Difficulty focusing or thinking
• Exhibit changes in their personality or mood

A brain contusion can also cause restlessness or agitation. In severe cases, it can lead to seizures or loss of consciousness.

The severity of symptoms depends on the location of the brain affected and the degree of damage to the brain tissue since different areas of the brain control different functions. An injury to the base of the brain could cause the most severe symptoms because that area of the brain (the brain stem) controls functions like breathing and heart rate.

Types of Brain Contusions

Brain contusions are generally categorized based on where bleeding is in the brain when observed in a scan. If the bruise is visible on the same side as the impact, the injury is referred to as a coup contusion, which is the most common type of brain contusion.

Contrecoup contusions are located on the side opposite the impact and are more severe than coup contusions. They are typically seen when a person’s head is moving at the time of the injury, such as in a motor vehicle accident or fall.

Some areas of the brain are more likely than others to be affected by a brain contusion. The front (frontal lobe) and side (temporal lobe) of the brain are more prone to these injuries because of the shape of the skull in those areas. The inside of the skull is generally smooth but has several ridges on the inside that can cause damage if the brain moves inside because of an impact.

How Are Brain Contusions Treated?

Because brain contusions typically result from an impact, treatment initially focuses on supporting breathing and blood flow. This might involve oxygen support or surgery.

A computed tomography (CT) scan will help healthcare providers determine whether surgery is needed to address bleeding. When bleeding is present, a surgeon may remove a part of the skull to relieve the pressure and prevent further injury to the brain. Because more than 80% of brain contusions involve bleeding that can make the injury worse, bone removal is a common strategy to protect the brain and may be used in brain contusion treatment.

In the case of mild brain contusion, you will likely be advised to rest. You may need to take medications to prevent any additional injury caused by the contusion. These can include anti-seizure medicines and diuretics that reduce the amount of fluid in your body to decrease swelling.

Rehabilitation could include other healthcare professionals, including occupational therapists who can help you regain skills related to your activities of daily living, physical therapists who may help with balance and strength, and speech and language therapists if the injury affected your speech.

How Soon After Treatment Will I Feel Better?

The degree of recovery after a brain contusion depends on a number of factors, including the cause of the injury.

Most people with mild brain contusion have symptoms that resolve between one week and three months after the injury. Most recoveries will occur in the first week.

In cases where the injury is caused by a violent impact, like a motor vehicle accident or a fall from a significant height, you may spend time in the hospital and have a longer recovery time.

Other factors like age, biological sex, prior brain injury, and overall health can also affect how quickly someone will feel better after a brain contusion. People assigned female at birth, for example, tend to recover from brain contusions and other types of brain injuries more quickly. However, this conclusion could be confounded by the fact that males tend to suffer more violent injuries and may not be as compliant with treatment.

Avoiding activities that may be risk factors for brain contusions and following the advice of a healthcare provider even if you’re feeling better will increase your chances of full recovery.

Should I Go to the Doctor for a Brain Contusion?

If you have suffered a blow to the head and are experiencing any symptoms of a brain contusion, you should see a healthcare professional immediately. The earlier the injury is evaluated and treated, the higher your chances of a full recovery.

What Questions Should I Ask My Provider?

If you see a healthcare provider for a suspected brain contusion, you may have questions about what to expect and what you can do to support your recovery. Below are some questions that will help guide your understanding of what happens after an injury:

• Should I have someone stay with me? And for how long?
• What kinds of symptoms can I expect to experience?
• What symptoms are concerning and warrant immediate medical attention?
• What kinds of activities can I do in the next few days? Weeks?
• When is it safe to return to normal activity and work?
• What over-the-counter medicines are safe to use?
• When should I schedule a follow-up visit?

What Are the Healing Stages of a Brain Bruise?

Recovery from a brain contusion will be highly individual, with people with mild injuries recovering more quickly than those with severe injuries.

In general, the brain undergoes a great deal of recovery in the first two months after an injury. During this time, brain swelling decreases. If the person has been in a coma, they may become alert and responsive. In more mild forms of brain contusion, headaches will subside, and memory issues or fatigue may begin to resolve. Measurable improvements will be seen on a nearly weekly basis.

From three to six months after the injury, the brain begins to change and adapt to any permanent injuries. Significant recovery is experienced during this time, but the person may feel that recovery is happening more slowly or is plateauing. This is normal as the brain is learning new ways of doing tasks.

After six months, supportive therapies, including physical and occupational therapy, will continue to refine the person’s skills. Recovery after six months will feel slow but can make significant differences in the person’s ability to recover completely.

How Can I Prevent Brain Contusions?

Most brain contusions are caused by accidents that result in a blow to the head. Prevention strategies focus on protecting the head while playing sports, driving, or spending time at home.

Sports

Wearing protective equipment like helmets while engaging in high-impact sports like football, rugby, and lacrosse can help protect your head from the effects of impacts.

Driving

Wearing a seat belt and ensuring your car’s airbags are working properly can ensure your head stays as safe as possible if you’re in an accident. Helmets are also important when you are driving vehicles without a cabin, such as motorcycles and snowmobiles.

At Home

Installing handrails for stairs, securing throw rugs, and removing clutter from your home can reduce the risk of falling. You can also install grab bars and use non-slip mats in bathtubs.

The Road to Full Recovery

Brain contusions will often result in deficits immediately after the injury that can resolve over time. Committing to therapies, even when progress feels slow, will increase your chances of achieving full recovery.