Profile of coup and contre-coup damages in head injury: An autopsy based study

Background: It has been witnessed commonly during autopsy of persons who have died as a consequence of head injury that internal damages occurred diagonally opposite to the point struck rather than the underlying area of scalp at which the traumatic force was applied. Even during clinical examination of medico-legal cases, it has been noticed many times that location of various damages on CT head findings doesn't coincide with that of external wounds. The current study was undertaken with an objective to understand the profile of coup and contrecoup damages in head injury in medicolegal cases brought for autopsy. Material &Methods: The study was conducted in a tertiary care center of northern India over a period of two years. The location of skull fractures and various intracranial damages in form of extradural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, contusions and lacerations of brain were observed and compared in relation to external impact. Results: Maximum (85) lesions were coup followed by coup-contrecoup (48). Skull fractures were predominantly coup (92.7%), while only one case showed contrecoup fracture. Subarachnoid hemorrhages were observed as coup-contrecoup lesion in majority of cases (69%). Contusions were largely detected as contrecoup lesions (55.9%). Conclusion: Internal damage not corresponding to the site of external impact in head injury cannot be refuted. While reporting and inferring the intracranial injury during head trauma cases, the force of impact and area of skull stuck should be considered.