What are the follow-up procedures for a cerebral contusion (head contusion)?

From the Guidelines

For a cerebral contusion follow-up, patients should be monitored for 24-48 hours after the injury, watching for worsening symptoms such as headache, confusion, vomiting, seizures, unusual drowsiness, or unequal pupils, which require immediate medical attention. Rest is essential for recovery, with gradual return to normal activities as symptoms improve. Patients should be informed about postconcussive symptoms, which can include headache, sleep disturbances, dizziness/vertigo, nausea, fatigue, oversensitivity to noise/light, attention/concentration problems, memory problems, irritability, anxiety, depression, and emotional lability 1.

Key aspects of follow-up care include:

• Monitoring for signs of complications, such as worsening headache, confusion, or vomiting
• Providing patients with clear discharge instructions, including information on postconcussive symptoms and when to seek medical attention
• Ensuring patients understand the importance of rest and gradual return to normal activities
• Considering the use of acetaminophen (Tylenol) for pain management, while avoiding NSAIDs like ibuprofen initially due to potential bleeding risk
• Applying cold compresses to the injured area to reduce swelling, as needed

It is crucial to note that while most head contusions resolve within 1-2 weeks without complications, monitoring is essential because they can occasionally mask more serious injuries with delayed symptoms. If symptoms persist beyond two weeks or worsen at any point, patients should seek medical evaluation. The decision to discharge a patient with a mild traumatic brain injury (TBI) from the emergency department must be coupled with appropriate discharge instructions, including information on postconcussive symptoms and when to seek medical attention 1.

In terms of neuroimaging, CT is the test of choice to evaluate for intracranial hemorrhage during the first 24 to 48 hours after injury, while MRI provides better detection of cerebral contusion, petechial hemorrhage, and white matter injury, especially if imaging is needed 48 hours or longer after an injury 1. However, the use of neuroimaging should be guided by clinical criteria and the patient's specific situation.

Overall, the follow-up care for a cerebral contusion should prioritize monitoring for complications, providing clear discharge instructions, and ensuring patients understand the importance of rest and gradual return to normal activities, all while considering the potential for postconcussive symptoms and the need for further medical evaluation if symptoms persist or worsen.

From the Research

Follow-up Procedures for Cerebral Contusion

• The follow-up procedures for cerebral contusion (head contusion) may vary depending on the severity of the injury and the presence of symptoms 2, 3, 4, 5, 6.
• For patients with mild head injuries, follow-up care may not be necessary if they are asymptomatic and have a normal neurologic examination 5.
• However, patients with moderate or severe head injuries may benefit from routine follow-up, as they are more likely to experience difficulties with everyday activities 2.
• The use of repeat head CT scans in outpatient follow-up for nonoperative cerebral contusion and traumatic subarachnoid hemorrhage may not alter clinical decision-making in asymptomatic patients or those with mild, nonspecific symptoms 6.
• Patients with significant symptoms or focal findings on neurological examination may require repeat CT scans and changes in treatment plan 6.

Patient Stratification

• Patients can be stratified into different groups based on their neurological symptoms, including:
  • Asymptomatic patients
  • Patients with mild, nonspecific symptoms (e.g. minor headaches, vertigo, fatigue)
  • Patients with significant symptoms (e.g. moderate to severe headaches, nausea, vomiting, focal neurological complaints) 6
• Each group may require different follow-up procedures and treatment plans.

Treatment and Management

• Treatment for cerebral contusion and traumatic subarachnoid hemorrhage is individualized and depends on the specific complaints of the patient 4.
• Medications and psychologic treatments may be used to manage symptoms, and ongoing basic and clinical research is crucial to provide more efficacious treatment in the future 4.
• A practical protocol for managing head-injured patients in the emergency department can help avoid the overuse of radiologic examinations and identify patients with possible life-threatening complications 5.