Coup and contrecoup injury

Mechanisms

Coup injury may be caused when, during an impact, the brain undergoes linear acceleration and deceleration forces or rotational forces, causing it to collide with the opposite side of the skull. These forces directly disrupt neurons, axons, other neural and meningeal structures, and blood vessels in local or diffuse patterns, typically leading to various cellular, neurochemical and metabolic effects.

Features

Contrecoup, which may occur in shaken baby syndrome and vehicle accidents, can cause diffuse axonal injury. In some circumstances, concussive injury can cause microvascular disruption, hemorrhage, or subdural hematoma.

Closed head injury (coup contrecoup) can damage more than the impact sites on the brain, as axon bundles may be torn or twisted, blood vessels may rupture, and elevated intracranial pressure can distort the walls of the ventricles. Diffuse axonal injury is a key pathology in concussive brain injury.

Contrecoup contusions are particularly common in the lower part of the frontal lobes and the front part of the temporal lobes. Injuries that occur in body parts other than the brain, such as the lens of the eye, the lung, and the skull{{cite book |vauthors=Gennarelli GA, Graham DI |chapter=Neuropathology |veditors=Silver JM, McAllister TW, Yudofsky SC |title=Textbook Of Traumatic Brain Injury |publisher=American Psychiatric Association |location=Washington, D.C. |year=2005 |page= 29| isbn=1-58562-105-6 |accessdate=2008-06-10 |chapter-url = https://books.google.com/books?id=3CuM6MviwMAC&q=neurotrauma&pg=PA47

History

In the 17th century, Jean Louis Petit described contrecoup injuries. In 1766, the French surgeon Antoine Louis coordinated a meeting of the Académie Royale de Chirurgie on contrecoup injuries, at which papers were to be presented, one of which would be chosen to receive the respected prize, the Prix de l'Académie Royale de Chirurgie. The presenter of the chosen paper was not awarded the prize because he failed to make recommended changes. In 1768, the group met again on the topic, and Louis Sebastian Saucerotte won the prize for his paper describing contrecoup injuries in humans and experiments on animals and recommending treatments such as bloodletting and application of herbs to patients' heads.

In popular culture

• In the Perry Mason TV series, contrecoup lacerations were used as evidence in at least two episodes, including "The Case of the Jaded Joker" (1959) and "The Case of the Bluffing Blast" (1963).
• In "Hawkeye", an episode of MASH*, Captain Hawkeye Pierce, M.D. diagnoses himself as having a contrecoup injury.
• In "Meld", an episode of Star Trek: Voyager, the ship's doctor is able to use the distinction between coup injury and contrecoup injury to determine that a dead crewman was murdered.
• "Contrecoup" is the title of a They Might Be Giants song off their 2007 album The Else. It was written as a challenge to create a song using the words "contrecoup", "craniosophic", and "limerent", and likens an infatuation to the effects of a traumatic brain injury.
• In Stephen King's novel Duma Key, the main character has brain damage from a contrecoup injury (spelled "contracoup").
• The distinction between coup and contrecoup injuries is described and portrayed in "Betrayal, Part 2", a 2019 episode of the BBC television drama series Silent Witness.

References

References

1. Poirier MP. (2003). "Concussions: Assessment, management, and recommendations for return to activity". Clinical Pediatric Emergency Medicine.
2. (1998). "Acceleration-deceleration injuries to the brain in blunt force trauma". American Journal of Forensic Medicine and Pathology.
3. (2002). "Pathology of head trauma". Neuroimaging Clinics of North America.
4. (2012). "Axonal Pathology in Traumatic Brain Injury". Experimental Neurology.
5. (2015). "Traumatic Brain Injury, Part I".
6. Bernhardt DT. (December 18, 2007). "Concussion". eMedicine.com.
7. NINDS. "Traumatic Brain Injury: Hope Through Research". National Institute of Neurological Disorders and Stroke.
8. (2014). "The neuro-ophthalmology of head trauma". The Lancet Neurology.
9. (2015). "The Concussion Toolbox: The Role of Vision in the Assessment of Concussion". Seminars in Neurology.
10. (2013). "Associated injuries in traumatic sternal fractures: A review of the National Trauma Data Bank". The American Surgeon.
11. (2000). "Grading Scale for Cerebral Concussions". Barrow Neurological Institute.
12. Finger S. (2001). "Origins of Neuroscience: A History of Explorations into Brain Function". Oxford University Press.
13. [https://www.springfieldspringfield.co.uk/view_episode_scripts.php?tv-show=perry-mason-1957&episode=s02e18 Transcript]
14. [https://www.springfieldspringfield.co.uk/view_episode_scripts.php?tv-show=perry-mason-1957&episode=s06e14 Transcript]
15. [https://www.wnyc.org/story/phantom-limb-phenomena/ Archive of "The Next Big Thing" radio, Jan. 13, 2005], Perry Mason clip played at 23:43 and 28:25.
16. Liu, Jonathan H.. "Save the Words!".