The following lesions require immediate surgical approach and must be recognised in the emergency room. Cerebral contusion means damage to a portion of the brain and may be characterised by dulled mentation, pink cerebrospinal fluid and a sensory motor deficit. Contused frontal or temporal lobes may have to be resected if sufficient swelling occurs. CT scan may show clinically undetected contusion. If the contusion is large or associated with edema, the mass effect may cause hernietion and brain stem compression.
Contusion require surgery only if mass effect occurs.
A fixed pupil on the same side as the impact area is a hallmark of this injury. Craniotomy must be performed to evacuate the clot and stop the source of bleeding when a change of neural function indicates continuos bleeding. Urgent surgical treatment without studies may be lifesaving. Brain injury may results if the haematoma is not evaquated immediately. In this patology there is a variable amount of freshly clotted blood in the subdural space, accompanied by severe contusion of the underlying brain.