Tuesday 30 August 2011

Emedinews:Insights on Medicolegal issues:What is the countercoup injury of brain?

• Two types of impacts occur on skull and the sound wave elicited by the impact. The first at the site where the force is applied, the second where the advancing segments of the accelerated brain are brought suddenly to rest by the forces that resist its forward motion.
• Counter coup lesions of the brain were once thought to be caused by the brain moving within the skull in a straight line with the force of the blow striking against its opposite side, but from experiments on mechanics of head injuries it has demonstrated the countercoup lesions are chiefly due to local distortions of the skull and the sudden rotation of the head as result of a blow, which arouse shear strains or slide produced by the pulling apart of the constituent particles of the brain .
• Shear strains occur due to pulling apart of the constituent particles of the brain. They occur in all parts of the brain, but to a large extent at the base of the frontal lobe and the tip of the temporal lobe, as the skull gets a good grip on the brain in this region owing to the projecting ridge of the sphenoid bone. Hence, severe and extensive injuries occur in this region when a blow is struck on the occiput.
• On the other hand, countercoup injuries which are caused by rotation will not occur if the head is so well fixed that it cannot rotate at all when it receives a blow. Cerebral contusions and tears have been reported in autopsy as a result of trauma.

(References Modi’s medical jurisprudence 25th edition)
(Contributed by Dr Sudhir Gupta)

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