0:00

As I mentioned previously,

0:02

I sometimes will use the term contusion and parenchymal

0:06

hematoma interchangeably.

0:08

However, most people will think of a contusion

0:12

as a brain bruise,

0:14

which is a little bit more diffuse and less well defined,

0:17

versus a parenchymal hematoma,

0:20

which is sort of more of a consolidated area of all

0:24

the hemorrhages that can occur from contusion.

0:27

Both contusions and parenchymal hematomas can occur in the

0:33

coup area of the direct trauma or the contrecoup.

0:38

from the brain motion. And in fact,

0:41

contusions occur more commonly with contrecoup and

0:45

parenchymal hematomas generally occur

0:47

more commonly with contrecoup.

0:49

If one sees an initial CT scan that is normal

0:55

or has mere subarachnoid hemorrhage,

0:58

and then over the course of the follow up,

1:00

within the first 24 hours,

1:02

a parenchymal hematoma develops.

1:05

That delayed intraparenchymal hematoma generally has a

1:09

worse prognosis than if the patient presents initially

1:12

with the intraparenchymal hematoma because it implies

1:16

a more of a diffuse process going on in the brain.

1:19

Let's look at a few slides of cortical contusions

1:24

and contrecoup parenchymal hematomas.

1:27

So, here we have a patient on CT scan where one has an

1:32

initial evaluation, where there's just some faint blood

1:36

products that are seen in the right parietal region.

1:40

However, this patient also has a larger,

1:45

more consolidated collection of blood.

1:48

So this area I would use the term contusion,

1:53

whereas in the further inferior region, one sees a better

1:59

defined, more dense collection of hemorrhage.

2:02

And for this,

2:04

I would use the term hematoma or parenchymal

2:07

hematoma or intraparenchymal hematoma or IPH.

2:11

Again, more of the bruise versus the parenchymal hematoma.

2:18

This is another example of a patient who has a lesion

2:23

along the inferior aspect of the

2:26

anterior cranial fossa floor.

2:28

So, one notes that there is a lower density area here in

2:33

the left anterior cranial fossa region of the inferior

2:37

frontal lobe and it gets much larger as

2:42

one proceeds further superiorly.

2:45

You'll notice that there are some areas that are

2:47

hyperdense representing blood products.

2:50

So this, again, would be something that we would refer to

2:52

more as a contusion because it's not as dense and

2:56

well consolidated as a parenchymal hematoma.