title: Contrecoup Traumatic Intracerebral Hemorrhage: A Geometric Study of the Impact Site and Association with Hemorrhagic Progression.
abstract: Traumatic intracerebral hemorrhage (TICH) represents 13-48% of the lesions after a traumatic brain injury (TBI). The frequency of TICH-hemorrhagic progression (TICH-HP) is estimated to be approximately 38-63%. The relationship between the impact site and TICH location has been described in many autopsy-based series. This association, however, has not been consistently demonstrated since the introduction of computed tomography (CT) for studying TBI. This study aimed to determine the association between the impact site and TICH location in patients with moderate and severe TBI. We also analyzed the associations between the TICH location, the impact site, the production mechanism (coup or contrecoup), and hemorrhagic progression. We retrospectively analyzed the records of 408 patients after a moderate or severe TBI between January 2010 and November 2014. We identified 177 patients with a total of 369 TICHs. We found a statistically significant association between frontal TICHs and impact sites located on the anterior area of the head (OR 5.8, p < 0.001). The temporal TICH location was significantly associated with impact sites located on the posterior head area (OR 4.9, p < 0.001). Anterior and lateral TICHs were associated with impact sites located at less than 90 degrees (coup) (OR 1.64, p = 0.03) and more than 90 degrees (contrecoup), respectively. Factors independently associated with TICH-HP obtained through logistic regression included an initial volume of <1 cc, cisternal compression, falls, acute subdural hematoma, multiple TICHs, and contrecoup TICHs. We demonstrated a significant association between the TICH location and impact site. The contrecoup represents a risk factor independently associated with hemorrhagic progression.
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Santiago
authors.initials: S
authors.lastname: Cepeda
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Gómez
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Ana María
authors.initials: AM
authors.lastname: Castaño-Leon
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Munarriz
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Igor
authors.initials: I
authors.lastname: Paredes
authors.affiliation: Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid , Madrid, Spain .
authors.forename: Alfonso
authors.initials: A
authors.lastname: Lagares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020202:Cerebral Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: TICH; contrecoup; contusion; intracerebral hematoma; traumatic brain injury