In this clinical review paper, the clinical concepts from the latest literature will be synthesized about this type of injury, its incidence, physiology, pathophysiology, clinical manifestations, diagnostic methods used in the practice, and implications on the advanced nurse practice management. Basically coup/contrecoup arises from contusive injury to the brain when both the impact of direct trauma and trauma due to movement of the brain within the skull leading to impact on the opposite site are responsible. However, the clinical signs and symptoms and as a result, the management would depend on the degree of the trauma and the extent of the injury. Nurses, while planning a care of such patients must be aware of the advancements in management, and a clinical update based on review of the researches is therefore necessary. In this article, the findings have been presented in a concise manner.
The problem of head injury is enormous. In the United States, it accounts for fatalities, disabilities, and morbidities of great numbers each year. Moreover, many multitruama victims also have associated head injuries. This occurs predominantly among young adult males aged 15 to 35 and quite frequently is associated with motor vehicle accident and alcohol use. In these patients, especially when it is associated with multiple traumas, the presence of head injury can be caused by trauma, direct or indirect. From the care point of view, this represents both surgical and medical challenges. Essential to the survival is a rapid and systematic approach to management that incorporates simultaneous assessment and resuscitation. Coup/contrecoup injury is the result of contusive brain injuries that occur with blunt trauma, in which the skull is not penetrated. It is to be remembered that anatomically brain literally floats in the cerebrospinal fluid, and therefore, any mechanical impact, either from falls, automobile accidents, assaults and violence, physical abuse, or recreation-related accidents, can cause the brain to move within the skull, resulting in focal, diffuse, or generalized injury. In fact any time, the head is subjected to violent force or motion, the soft and floating brain is slammed against the skull's uneven interior. In a coup/contrecoup injury, a moving object strikes the head, denting the skull inward and also knocking the brain against the opposite side of the skull. Thus, this can result into bruising in two places within the brain, at the site of the original point of contact and on the opposite side, where the brain struck the skull. These are included in the category of mild traumatic brain injury, where the neural damage may occur without involvement of the skull or the membranes, since there is considerable shear that can involve the neurons on the opposite side. This is a form of direct contact force mild traumatic brain injury resulting into observable tissue damage in a particular area of the brain. The additional bruising on the opposite side may account for other associated symptoms such as personality changes, perceptual or sensory problems, difficulty expressing, and balance or motor difficulties.
Epidemiologic data regarding coup/contrecoup injury is difficult to obtain due to inconsistencies in definition and classification. Moreover, many patients with