Cerebral Concussion vs. Cerebral Contusion
Left picture: The diagnosis is a cerebral concussion, or, depending on the clinical course and/or the CT findings, a slight form of cerebral concussion. Right picture: This patient has a severe head injury with a cerebral concussion. The differentiation of the cause of the wide and fixed pupil following an uncal herniation is only possible with a CT; in the presented case a focal contusion in the left hemisphere with perifocal edema was found, not the suspected epidural hematoma.
Both schoolchildren have a clouding of consciousness; their eyes are closed. Left picture: In this pathology a head injury has occurred with bleeding from the nose and the mouth, and laceration of the lower lip; in addition, there is suspicion of a blunt abdominal trauma. Right picture: According to the clinical examination, only an isolated head injury has occurred. Left picture: The girl is not fully oriented to time and place, and does not open the eyes spontaneously (GCS maximum 13). The pupils, which are not shown in this picture, are narrow, symmetrical (= isocoria), and react promptly to light. Right picture: In this patient the GCS is roughly 8, and the left pupil is wide and fixed.