Skip to main content Accessibility help

Contrecoup injury in patients with traumatic temporal bone fracture

  • Z A Asha'Ari (a1), R Ahmad (a1), J Rahman (a2), N Kamarudin (a3) and L Wan Ishlah (a1)...



To study the prevalence and patterns of contrecoup injury in traumatic temporal bone fracture cases.


A prospective, cohort study was undertaken of all patients with traumatic head injury admitted to a tertiary referral hospital in Malaysia within an 18-month period. High resolution computed tomography scans of the brain and skull base were performed in indicated cases, based on clinical findings and Glasgow coma score. Patients with a one-sided temporal bone fracture were selected and subsequent magnetic resonance imaging performed in all cases. Contrecoup injury incidence, type, severity and outcome were recorded.


Of 1579 head injury cases, 81 (5.1 per cent) met the inclusion criteria and were enrolled in the study. Temporal bone fractures were significantly associated with intracranial injuries (p < 0.001). The incidence of a contrecoup injury in cases with temporal bone fracture was 13.6 per cent. Contrecoup injury was significantly associated with petrous temporal bone fracture (p < 0.01). The commonest contrecoup injury was cerebral contusion, followed by extradural haematoma and subdural haematoma.


Contrecoup injury is not uncommon in cases of temporal bone fracture, and is significantly associated with petrous temporal bone fracture.


Corresponding author

Address for correspondence: Dr Zamzil Amin Asha'Ari, Assistant Professor, Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, International Islamic University Malaysia, Jalan Hospital, 25100 Kuantan, Pahang, Malaysia Fax: 609 5133615 E-mail:


Hide All
1Poirier, MP. Concussions: assessment, management, and recommendations for return to activity. Clin Pediatr Emerg Med 2003;4:179–85
2Morrison, AL, King, TM, Korell, MA, Smialek, JE, Troncoso, JC. Acceleration-deceleration injuries to the brain in blunt force trauma. Am J Forensic Med Pathol 1998;19:109–12
3Hardman, JM, Manoukian, A. Pathology of head trauma. Neuroimaging Clin N Am 2002;12:175–87
4Mitsuyama, T, Ide, M, Kawamura, H. Acute epidural hematoma caused by contrecoup head injury. Neurol Med Chir 2004;44:584–6
5Hardin, MF. A case of contrecoup vestibular injury. Kans Med 1996;97:1415
6Balasubramaniam, V, Ramesh, VG. A case of coup and contrecoup extradural hematoma. Surg Neurol 1991;36:462–4
7Jones, RM, Rothman, MI, Gray, WC, Zoarski, GH, Mattox, DE. Temporal lobe injury in temporal bone fractures. Arch Otolaryngol Head Neck Surg 2000;126:131–5
8Ulug, T, Ulubil, SA. Contralateral labyrinthine concussion in temporal bone fractures. J Otolaryngol 2006;35:380–3
9Ryan, GA, McLean, AJ, Vilenius, AT, Kloeden, CN, Simpson, DA, Blumbergs, PC et al. Brain injury patterns in fatally injured pedestrians. J Trauma 1994;36:469–76
10Lee, HJ, Lum, C, Means, K, Chandrasekhar, S, Brown, L, Holodny, A et al. Temporal bone fractures and complications: correlation between high-resolution computed tomography and audiography. Emerg Radiol 1998;5:812
11Saraiya, PV, Aygun, N. Temporal bone fractures. Emerg Radiol 2009;16:255–65
12Brodie, HA, Thompson, TC. Management of complications from 820 temporal bone fractures. Am J Otol 1997;18:188–97
13Yavuz, MS, Asirdizer, M, Cetin, G, Balci, YG, Altinkok, M. The correlation between skull fractures and intracranial lesions due to traffic accidents. Am J Forensic Med Pathol 2003;24:339–45
14Ishman, SL, Friedland, DR. Temporal bone fractures: traditional classification and clinical relevance. Laryngoscope 2004;114:1734–41
15Besenski, N. Traumatic injuries: imaging of head injuries. Eur Radiol 2002;12:1237–52
16Drew, LB, Drew, WE. The contrecoup-coup phenomenon: a new understanding of the mechanism of closed head injury. Neurocrit Care 2004;4:385–90
17Gurdjian, E, Gurdjian, ES. Cerebral contusions: re-evaluation of the mechanism of their development. J Trauma 1976;16:3551
18Dahiya, R, Keller, JD, Litofsky, NS, Bankey, PE, Bonassar, LJ, Megerian, CA. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Trauma 1999;47:1079–83



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed