Some patients with head injury may suffer contusions of both frontal lobes. These patients often present what appears to be relatively minor findings, only to deteriorate and die a few days later (“talk and die”).


Patient selection: head injury


Criteria for extensive bifrontal contusions – all of the following:

(1) contusion volume of the left frontal lobe > 10 mL.

(2) contusion volume of the right frontal lobe > 10 mL/

(3) total volume of left and right frontal lobe contusions > 30 mL


Clinical features:

(1) The patient presents with a high Glasgow Coma Score (GCS), typically >= 11.

(2) The patient deteriorates 4 or more days after the injury (late deterioration).

(3) If deterioration occurs it tends to be rapid.


Management recommendations:

(1) The patient should be admitted to the ICU despite the benign clinical appearance.

(2) Prophylactic hypertonic saline infusions should not be given.

(3) Early intracranial pressure monitoring is recommended.

(4) If the patient deteriorates then bifrontal decompression should be performed quickly.


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