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Concussion
Last reviewed: 07.07.2025
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Contusion is a closed mechanical injury to soft tissues or internal organs without visible disruption of their anatomical integrity.
Contusion occurs as a result of a blow with a blunt hard object or when falling on a hard surface. When internal organs are damaged, there is either a direct impact of a traumatic agent, a blow to the lung or liver with a displaced rib, a blow to the brain with a displaced bone fragment in depressed fractures; or a deceleration mechanism develops, when the organ is displaced by inertia with a blow to the wall, for example, the brain on the cranium, the lung on the chest wall, etc. Clinically, superficial contusion in most cases produces local changes. Contusion of internal organs forms a systemic pathology, and sometimes has severe complications in the form of ruptures, sometimes biphasic, bleeding, etc.
Superficial contusion
The severity of the contusion depends on the area of application of force, the direction of the blow, the kinetic energy of the damaging agent. When struck at an angle of 90 degrees to the body surface, the integrity of the skin is not damaged due to the high strength and resistance of the skin to mechanical impacts. But with high kinetic energy (more than 2 kg/cm2), contused wounds can form. When struck at an angle of 30-75 degrees to the body surface, skin abrasions are formed, and with a sharper angle of application of force, detachment occurs with the development of a subcutaneous hematoma due to the tangential impact on soft tissues and skin.
Clinical manifestations depend on the site of application of force. An uncomplicated contusion in the soft tissue area is clinically accompanied by pain at the time of contusion, which quickly subsides, and after 1-2 hours again intensifies due to irritation of the nerve endings by the developing edema and bruise (alteration). The time of injury is determined by the color of the bruise: the first 2 days it has a purple-violet hue; up to the 5-6th day - blue; up to the 9-10th day - green; up to the 14th day - yellow - gradually fades as hemosiderin is absorbed.
Complicated ones include: contusion in the area of joints, which causes hemarthrosis; contusion in the area of the head, spine, chest and abdomen, which often damage internal organs. Contusion with high kinetic energy in the area of bones leads to their fractures. Blows to certain points or zones can cause a shock reaction, even a fatal outcome.
Organ contusion
Diagnosis of brain damage
There are three degrees of severity of concussions and bruises of the brain. The main differential diagnostic symptom of the presence of brain injury and its severity is loss of consciousness. Other symptoms play an auxiliary role and should be carried out by a neurosurgeon.
Concussion is a mild and reversible form of craniocerebral trauma with predominantly functional disorders of the central nervous system. But the outcome of the injury largely depends on the correctness of the treatment and, most importantly, on compliance with the bed rest period. Which is very difficult to achieve in such victims, since they do not realize the severity of the injury (Anton-Babinsky symptom).
The main criterion for diagnosing a concussion is a short-term loss of consciousness from a few seconds to 30 minutes. The pathological substrate of a concussion is its edema and swelling (alteration). As the edema and swelling of the brain subside, the damage quickly regresses.
Clinically, concussion is accompanied by headaches, dizziness, weakness; nausea and vomiting may be observed, which quickly cease. Characteristic: horizontal nystagmus, decreased pupillary response to light stimulation, smoothing of the nasolabial fold, which also quickly subside. Pathological meningeal reflexes are not detected. Cerebrospinal fluid is normal. Sometimes vegetative disorders are observed in the form of: increased blood pressure, tachycardia, increased body temperature, rapid breathing, which quickly pass.
Contusion has a distinct pathological anatomical substrate: in the form of subarachnoid hemorrhages (flat or wedge-shaped, extending deep into the brain) in the area of force application; hemorrhagic softening and foci of destruction. Most often, contusion foci form in the area of the cerebral cortex or cerebellum; less often in the brainstem; or in various combinations of hemispheric and cerebellar foci. According to the severity of damage and clinical manifestations, three degrees of contusion are distinguished.
Contusion of the 1st degree
In case of first-degree contusions, small subarachnoid hemorrhages, edema and swelling are formed. Loss of consciousness lasts from 30 minutes to 1 hour. Clinical manifestations are more pronounced than in case of concussion: they are long-lasting, persistent, can increase from the 2nd-3rd day after the injury, their regression is long and occurs no earlier than 2 weeks after the injury. A distinctive feature is the symptom of retrograde amnesia, when the victim cannot remember the circumstances of the injury. It does not manifest itself in all cases, but it is pathognomonic for brain contusions. In case of first-degree contusions, this symptom is transient and subsides within a week. Paralysis and paresis are not observed.
Neurological symptoms after consciousness recovery are clear: headaches, dizziness, nausea; vomiting is rare. On examination: horizontal nystagmus, decreased pupillary response to light, smoothing of the nasolabial fold. On examination of peripheral innervation, asymmetry of reflex excitability. Vegetative-vascular changes do not differ from manifestations in concussion.
Second degree contusion
The anatomical substrate determining this degree of contusion is the development of planar subarachnoid hemorrhages, sometimes occupying entire fields. Loss of consciousness from 1 to 4 hours. Sometimes respiratory and cardiac disorders are noted, requiring replacement therapy, up to resuscitation aids, but compensation, with adequate treatment, occurs within the first day.
Clinically, after recovery of consciousness, a second-degree contusion is accompanied by severe headaches, dizziness, lethargy, and adynamia; retrograde amnesia is long-term (from a week to several months), but transient.
On examination: pronounced horizontal nystagmus; smoothing of the nasolabial fold; rigidity of the occipital muscles, dissymmetry of peripheral reflexes; hemiparesis or hemiplegia may occur; plantar reflex, Kernig and Babinski reflexes. But all these symptoms and syndromes are transient, although long-term. Most often, the process ends with the formation of areas of brain dystrophy or adhesions of the meninges, which determines the mass of neuropathological conditions in the post-traumatic period.
III degree contusion
The anatomical substrate that determines the development of a grade III contusion is: extensive subarachnoid hemorrhages in the area of impact and counter-impact, as well as hemorrhages in brain tissue, sometimes even in the ventricles of the brain. In fact, such damage can be defined as hemorrhagic stroke.
The clinical picture is expressed in the form of prolonged loss of consciousness, more than 4 hours; persistent hemiparesis; disturbance of cranial innervation, presence of Kernig's and Babinski's symptoms.
Diagnosis of contusion injuries and differential diagnosis with intracranial and intracerebral hematomas, with which this contusion is often combined, should be carried out in specialized neurosurgery and intensive care units, where victims are hospitalized for emergency care.
Contusion of other organs
In 5-7% of cases of chest trauma, especially if the blow falls on the anterior chest and sternum, obvious cardiac contusion is formed. Clinically and according to ECG data, they are similar to myocardial infarction. In 43-47% of cases of closed chest trauma, hidden cardiac contusion is observed, which gives a clinical picture of coronary heart disease, but its cause is revealed only by special studies.
Kidney contusion is observed quite often, especially in cases of multiple injuries. The main criterion for diagnosis is the presence of obvious hematuria or microhematuria. A full range of examinations should be performed by a urologist for differential diagnosis with damage to other parts of the genitourinary tract.
The diagnosis of liver and spleen contusion is valid, but diagnostics are very difficult in cases of low severity, and more severe contusions form subcapsular ruptures. The same applies to contusions of hollow organs.
Diagnosis of contusion injuries of the lungs
In 42-47% of isolated chest injuries and in 80-85% of combined injuries, lung contusions are formed. As a rule, they are formed when falling on a ledge or from a height of more than two meters, or when there is an inertial displacement of the lung with a blow to the chest wall, for example, in car accidents.
During the first 6 hours, pronounced dyspnea and weakened breathing are observed. After which an improvement in the condition is noted, the clinical picture is smoothed out, but on the 2nd-3rd day after the injury, a characteristic deterioration in the condition occurs: chest pain increases, dyspnea reappears, physical and radiological changes are formed, which determine three degrees of severity of a lung or lung contusion.
Contusion of the 1st degree
Accompanied by the formation of alterative pneumonitis (not to be confused with pneumonia - purulent inflammation of the terminal sections of lung tissue) due to edema and hemorrhages in individual lobes of the lungs (hemoptysis is extremely rare - in 7% of cases).
Chest pains reappear when breathing and coughing, moderate cyanosis and dyspnea, and there may be subfebrile temperature. Auscultation: weakened breathing with fine bubbling or crepitating rales. Radiographs of the lungs, more often in the lower lobe, reveal multiple, small, medium-intensity, vague darkening of the lung tissue, there may be Kerley lines (horizontally located, low-intensity darkening lines along the lymphatic vessels). Deterioration continues until the 6th-7th day after the injury, with subsequent improvement.
Second degree contusion
Accompanied by the formation of exudative hemopleurisy with localization of effusion in the costophrenic sinus or interlobar groove. Dyspnea and cyanosis are more pronounced, there is a clinical picture of pleural syndrome. On chest radiographs, there is a homogeneous darkening in the area of effusion localization.
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III degree contusion
Accompanied by the formation of hemoaspiration or pulmonary atelectasis with the development of respiratory failure syndrome. A pronounced hypoxic syndrome and respiratory distress syndrome are formed. On chest radiographs: with hemoaspiration, multiple bilateral darkening of the lung tissue of the "snow blizzard" type; with pulmonary atelectasis - homogeneous darkening of the lung with a shift of the mediastinum towards the darkening.
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