Coup and Contrecoup injury

- Satavisha (099)
 Competency

• Fm 3.11 → describe and discuss regional injuries to head (scalp wounds, fracture
skull, intracranial haemorrhages, coup and contrecoup injuries), neck, chest,
abdomen, limbs, genital organs, spinal cord and skeleton.
 Coup injury

• Coup injury is one which occurs immediately

beneath the area of impact, and results directly
by the impacting force.
• Head is accelerated.
• Impact occurs first followed by motion.
 Contrecoup injury
• Contrecoup injury means that the lesion is
present in the brain opposite to the site of
impact.
• It is caused when the moving head is
suddenly decelerated by hitting a firm
surface.
• Motion occurs first followed by impact.
 Mechanism

• When head strikes the ground, a transient

deformation of the skull occurs with increase
in pressure , impinging on the underlying
brain causing compression—coup injury.
• Opposite area of the skull bulges out
accommodating the deformation— ‘struck-
hoop’ action.
Theories explaining contrecoup injury:

• Pressure gradient theory: At the site of impact the pressure is raised whereas
on the opposite side, the pressure is lowered.
• Rotational shear force theory: Advocated by
Holborn.

• Bony irregularities theory: Most contrecoup

injuries occur in frontal, temporal and parietal
areas of the brain.
• For example, if the head is fixed (person standing still) and there is violent impact over the frontal
bone, fracture and underlying brain damage will be located beneath the site of impact.

• For example, when a person falls with his occiput striking the ground, he sustains injury at the
occipital lobes (coup injury) and a more prominent injury to the frontal lobes (contrecoup injury)
INTERMEDIARY COUP
CONTUSIONS

• Contusions found in deeper structures of the brain, such as white matter, basal
ganglia, corpus callosum and brain stem along the line of impact, i.e., between
the coup and contrecoup points.
 Important points:

• Contrecoup injury is rare before the age of 3 years.

• There may be only contrecoup injury without any coup injury.
• There may be no fracture of skull, even in the presence of severe coup and contrecoup
lesions.
 Sites

• The most common site for contrecoup

injury is the frontal lobes.
• In temporal or parietal impacts, the
contrecoup lesions are usually on the
contralateral surface of the brain.
• It is rare for a fall on the frontal region
to produce occipital contrecoup.
 Medicolegal importance

• With blows (assault), brain shows much larger contusions underlying the area of impact (coup)
than on the site opposite to impact (Contrecoup).
• But, in head injuries caused by falls (e.g. road traffic accidents), the countrecoup injuries are
usually located in inaccessible portions and are larger. Coup lesions may be absent or minimal.
• With severe frontal contrecoup from a fall on the occiput, the force may cause fracture of the
floor of the anterior fossa resulting in ‘black eyes’.
• Contrecoup injury is seen in skull, brain, liver, heart and lungs.
Thankyou