How to manage a frontal brain contusion in my dad?

Question

Hello doctor,

My father had an accident recently. A CT scan done the same day showed swelling and a 13×11 mm hemorrhage in the frontal lobe. He is currently in another hospital.

They attempted several MRI scans, but these could not be completed because he was irritable. A follow-up CT scan today shows that the contusion has increased in size to 17×18 mm. I am not sure what this means.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out and sharing your concerns.

Your father’s CT (computed tomography) scans show a frontal brain contusion (a small area of bleeding and swelling) that has slightly increased in size, from approximately 13×11 mm to 17×18 mm over the past two to three days. Let me explain what this means and what steps should be taken next.

A. What this indicates:

A contusion is a bruise within the brain tissue caused by trauma. A mild increase in size during the first few days is not uncommon, as swelling (edema) around the bruise typically peaks about three to five days after the injury. The important and reassuring findings are:

No midline shift (no pressure pushing the brain to the opposite side).
No epidural or subdural bleed.
Normal ventricles and brainstem.

These findings suggest that, although there is an injury, it is not currently causing dangerous pressure on the brain.

B. Why was MRI (magnetic resonance imaging) not possible?

Because he is irritable or restless, it is difficult to keep him still during an MRI, which typically takes about 20 to 30 minutes. Sedation can be used later, if necessary, once he is more stable and calm, to check for any deeper or subtle injuries.

C. What to monitor now:

He must remain under close neurological observation, preferably in a hospital with a neuro ICU (intensive care unit). Watch for the following warning signs:

Increasing drowsiness, repeated vomiting, or severe headache.
Weakness in the limbs, unequal pupils, or confusion.

If any of these symptoms appear, a repeat CT scan should be done immediately.

D. Current treatment plan:

Strict bed rest with the head end slightly elevated.
Anti-edema measures: IV (intravenous) mannitol or hypertonic saline (if advised).
Avoid blood thinners or painkillers such as Diclofenac or Aspirin.
Antiepileptic prophylaxis may be started for seven to 10 days.
Pain and agitation control, along with proper hydration and nutrition management.

Most small frontal contusions heal gradually within two to three weeks, as the swelling subsides. Irritability and behavioral changes are common during recovery but are usually temporary. A follow-up CT scan after seven to 10 days, or sooner if symptoms worsen, is recommended.

Take care, and I hope this was useful.

Thank you.