Assess Management and Outcome of Patients with Traumatic Bifrontal Contusion

Background: Cerebral contusions involving the frontal lobes are important from the management point of view as sudden deterioration can occur in such patients at any point of time during the course of treatment. Objective: The purpose of this study is to assess the outcome in patients with bifrontal contusions& compare the conservative vs. surgical treatment. Material& methods: The clinical course of 100 head injury patients in whom CT had shown bifrontal contusion admitted between June 2017 to March 2019 to our hospital, were prospectively analyzed. Results: Early intervention was done in 24 patients of which 12 patients having contusion volume greater than50cm3 and 12 patients having contusion volume greater than 35cm3less than 50cm3 with GCS score of 6-8. Repeat CT scan was done in 35 patients showing neurological deterioration (↓ 2 points in GCS) or not showing neurological improvement within 48 hrs. Out of these 35 patients, 19 patients were seen having increase in contusion volume& were undergone delayed surgical intervention. Total 10 deaths were observed of which four deaths were observed in post op period. Four patients died due to rapid deterioration within 24 hours of admission. Two patients died after 7 days with GCS 9-13 who were conservatively managed with contusion volume less than 20 cm3. Mean value of hospital stay in early intervention was 8.46 ± 2.9 days and in late intervention was 11.58 ± 2.46 days. Both sudden& delayed deterioration complicated the clinical course of this disease with both increased mortality& morbidity in bilateral lesions. Conclusion: The management of a patient with bifrontal contusion is more difficult than a patient with contusions of other area of brain& intracranial hematomas as the bifrontal region is a silent area of brain and the quantum of injury, features of raised intracranial pressure are not clinically evident.