Acceleration-deceleration injuries to the brain in blunt force trauma

Blunt force trauma to the stationary head is generally associated with cortical-subcortical injuries located at the site of impact (i.e., coup contusions). We present 2 cases of cerebral contusion injury secondary to falling tree limbs hitting the head, illustrating an exception to this observation. In each case, the most prominent lesions were white matter hemorrhagic contusions similar to those associated with acceleration-deceleration types of injuries characterizing falls or motor vehicle accidents (i.e., contrecoup contusions). The proposed pathogenesis for these observed lesions is a forceful impact resulting in the acceleration of the head and brain of a magnitude comparable with that in a motor vehicle accident or a fall.