What are Coup/Contrecoup Injuries?

The terms Coup and contrecoup describe specific types of traumatic brain injury (TBI). Brain injuries are classified as closed head injuries (injury without a break in the skull), or penetrating head injuries (such as when a bullet pierces the brain).

What is a Traumatic Brain Injury?

Coup/Contrecoup Injuries

The CDC defines a traumatic brain injury as a disruption in the normal function of the brain caused by a bump, blow, or jolt to the head.

According to the CDC, in 2014, falls and motor vehicle accidents were the most common causes of all TBI-related hospitalizations in the U.S.

TBI is a major cause of death and disability in the United States.

Any head injury must be taken seriously. This is because injury to the brain does not necessarily end after the impact or injury event takes place.

The phrase “primary brain injury” refers to the actual moment of injury to the brain that is considered to be more or less complete at the time of impact. However, “secondary brain injury” refers to the changes that evolve over time after the primary brain injury. These are chemical, tissue, or blood vessel changes in the brain that contribute to further loss or injury to brain tissue.

What Happens to the Brain During a Traumatic Brain Injury?

In order to understand what happens to the brain during an injury, some knowledge of human anatomy is necessary.

The brain is not firmly affixed to the interior of the skull. Instead, it floats inside the skull in a liquid known as cerebrospinal fluid. The brain is also tangled within a network of blood vessels and is anchored by the spinal cord.

When an exterior force is applied, the brain can actually move and shift within the skull.

An external force on the head can cause the brain to strike the inside of the skull. This movement can cause cerebral contusions, bleeding on the brain, or brain swelling.

Coup or Contrecoup? That is the question.

The difference between a coup head injury and a contrecoup injury depends on how and where in the brain the injury occurs.

A coup injury is an injury to the brain occurring at the point of the impact to the head. If someone is hit by an object on their forehead and injury occurs to the front of the brain, that is a coup injury.

Contrecoup is a French word meaning “counterblow.” This type of injury to the brain involves an injury away from (and traditionally opposite to) the actual point of impact to the head. For example, if someone strikes their forehead against a solid object, the contrecoup injury occurs at the rear of the brain.

A contrecoup injury occurs when the brain rebounds in the opposite direction of the initial blow. Contrecoup injuries are caused when forces within the skull cavity apply stress on the brain and its related structures.

Coup and Contrecoup Injuries and Brain Trauma

As one might expect, the same traumatic event can cause both coup and contrecoup injuries.

Interestingly, though, contrecoup injuries are often more severe than coup injuries. In fact, there are many documented cases of patients suffering contrecoup injuries without coup injuries at all.

Why would this be? Below are a few theories that might explain this phenomenon:

  1. The movement of the brain in one direction causes magnified stress and damage to cerebral tissue at the opposite side.
  2. Bony protuberances and other irregularities in the skull’s interior can cause more injury to certain areas of the brain.
  3. Differences in density between the brain itself and the cerebrospinal fluid may also play a role in the injury.

The exact mechanism for the injuries, especially contrecoup injuries, is a subject of much debate. However, the key seems to be an abrupt deceleration of the head, causing the brain to collide with the inside of the skull.

Inertia is likely involved in the injuries. This is when the brain keeps moving after the skull is stopped by a fixed object. Alternatively, the brain remains still after the skull is accelerated by an impact with a moving object.

Any one of the three injury variations (coup, contrecoup or coup/contrecoup) can occur when a sudden external force causes movement of the brain within the skull. All three injury variations are common and serious causes of traumatic brain injury.

The Effects of Coup and Contrecoup Brain Injuries

Head injuries like coup and contrecoup can damage more than just the impact sites on the brain.

For example, diffuse axonal injury (DAI) is a common result of coup/contrecoup injuries. In this injury, the brain’s movements inside the skull tear the long connecting nerve fibers (axons). DAI is one of the most common and devastating types of traumatic brain injury.

Any type of TBI is serious and may cause permanent damage to the brain. If the injury is not managed promptly and properly, the patient could experience devastating complications which may lead to coma or death.

Due to the complicated nature of closed head injuries and the serious risk of long-term damage, it is important that anyone suffering ANY injury to the head seek medical attention. Even a relatively mild concussion can become fatal if serious symptoms develop or a second injury occurs to the same area.

Traumatic brain injuries can be physically, mentally, emotionally, and financially catastrophic.

Patients might experience long-term lifestyle changes, including permanent disability or the need for rehabilitation, re-learning, career re-training, and/or dependency on others.

Patients might also deal with years of pain and suffering and a severely depleted quality of life.

Signs and Symptoms of Traumatic Brain Injury

The symptoms and combinations of symptoms may or may not be present at the time of the injury. Symptoms can manifest days or even weeks following the trauma.

The symptoms and effects of a traumatic brain injury can vary widely and are not always consistent between individuals suffering even similar injuries. There are, however, numerous indicators to be aware of, including the following:

Potential Cognitive Effects of a TBI:

  • Loss of consciousness
  • Disorientation or confusion
  • Difficulty reading
  • Difficulty focusing
  • Attention difficulties
  • Impaired judgment
  • Loss of sense of time or space
  • Memory problems
  • Behavioral and/or mood changes
  • Speech difficulties, including difficulties with word choice and slurred speech

Potential Physical Effects of a TBI:

  • Headaches
  • Seizures
  • Dizziness
  • Lack of coordination
  • Problems with balance or equilibrium
  • Extreme or unusual fatigue
  • Nausea and/or vomiting
  • Visual changes
  • Sensitivity to light or to noises
  • Changes in vision, taste, smell and touch

Treatment For Coup and Contrecoup Brain Injury

Brain cells generally do not regenerate and recover once they are damaged or destroyed.

Treatment for coup and contrecoup brain injuries is usually focused on preventing further damage and restoring brain function rather than repairing and healing the brain tissue.

The brain is capable of compensating for the injury by establishing new routes of communication around areas of damaged tissue – especially in younger patients.

However, patients typically require treatment and rehabilitative therapy to help minimize the effects of brain damage and improve the long-term results.

Medical intervention is also important to prevent secondary damage to the brain. In some more serious cases, surgery may be required to alleviate internal pressure on the brain and prevent additional damage.

Compensation for Coup and Contrecoup Brain Injury

If you or a loved one suffered a traumatic brain injury due to an accident caused by negligence or malice, you should speak with a personal injury attorney who is qualified to handle brain injury cases.

A qualified brain injury attorney knows the true cost of your injury over a lifetime. An experienced personal injury attorney gives you the best chance for fair compensation to cover not only the medical expenses, but also other damages, including pain and suffering, disability, and loss of companionship.

At VanDerGinst Law, our injury lawyers are willing and able to fight relentlessly on your behalf for a recovery that you truly deserve.

Contact us at 800-797-5391 or through our website for a free consultation.

Learn More About TBIs From Our Podcast

Full Episode Transcript

Welcome to Legal Squeaks, I’m your host, Dennis VanDerGinst. Before getting in today’s topic, I’d like to remind you all please subscribe to or follow Legal Squeaks on your favorite podcast forum. It’s free. Make sure you tell your friends and family members to check us out as well.

Now, today’s topic is traumatic brain injuries or otherwise known as TBIs. TBIs can occur in any situation where there’s an injury case that arises either on the job, you know, in the course of a worker’s compensation claim or a negligence case where somebody has been injured. And it’s important to identify these situations because TBI’s can be so serious that the amount of compensation is largely increased when it exists.

But often they’re not highlighted, highlighted by the medical provider, and some attorneys will overlook the existence of TBI’s and therefore, somebody who has suffered in this fashion might not be properly compensated. So it is important that they they be properly identified, properly treated and properly, properly monitored.

So what is a TBI, what’s a traumatic brain injury? It’s the disruption of a normal function of the brain. It can be caused by a bump, blow, a jolt, a penetrating head injury. Some, sometimes it can also be caused by what might seem to be a whiplash injury. Now, there is some difference of opinion as to whether that’s the case. But I’ve certainly heard a lot of medical experts indicate that because of the nature of a whiplash injury and the brain kind of being rattled within the skull, just like the inside of an egg inside of its shell, that a TBI can occur in that fashion as well.

The Glasgow coma scale is used to classify the traumatic brain injury severe, severity into either mild, moderate or severe categories. It grades a person’s level of consciousness on a scale of 3 to 15, based on verbal motor and eye opening reactions to stimuli. A concussion, for instance, is a form of brain injury on the lower end of the severity scale. It’s often, in fact, referred synonymously as a mild TBI.

Some providers say that moderate or severe TBI’s have to accompany a loss of consciousness, but we’re finding that that’s not so anymore. There are more providers who are willing to state that loss of consciousness is not a prerequisite to being diagnosed with a moderate or severe TBI.

Some, sometimes the symptoms to a traumatic brain injury appear right away, but other times it might not be noticed for days or months after the injury or until person resumes their everyday life.

And that’s because sometimes they are focused on a more acute injury, for instance, a fracture or something like that that needs the immediate attention of the of a provider and is causing more, more pain, more attention to be paid to that portion of the body. So sometimes it takes a while.

In fact, other times they may not recognize or admit that they’re having problems. They may not understand that their problems, what the problems are and that the symptoms they’re experiencing are actually related to a traumatic brain injury. That’s kind of part of the problem. It’s a brain injury. So sometimes you can’t process information correctly.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems might be overlooked by the person, by the family members and even by the doctors. People might look fine, even though they may be acting or feeling differently. In the presence, as I mentioned, of a TBI, vastly enhances the value of the injury claims so the client’s physical and medical well-being as well as the financial well-being is often hinging upon properly identifying and treating TBI’s.

So you have to be aware that treatment providers might not follow up an initial diagnosis for concussion because they may feel there’s nothing else to be said or done other than what is in the discharge papers. So you, as either a patient or the family member of a patient, need to be sure that there’s some reasonable follow up to make sure that you’re documenting, as well as properly treating a TBI.

So some of the things that, that you need to be aware of. If you see that in your discharge papers or any of your medical records, there’s the mention of a concussion or the words traumatic brain injury, that’s a trigger for you. That, that’s something you have to be watching. If you see or you’re aware from any other source that there is a history of trauma to the head, again, that should alert you that you need to be watching and monitoring that patient, whether it’s yourself or someone else.

If you see or notice that the patient. Is having certain difficulties that I’m going to outline here, if you either see it in the records or you’re noticing it yourself or of a family or friend, a family member or friend, these are other things that should trigger you to to make sure that you are properly following up.

So if there are difficulties, for instance, in thinking clearly. If the person is feeling slow down. They’re having problems concentrating, difficulty remembering new information. If they’re experiencing headaches. If they have vision problems. If they especially early on, if they have nausea or vomiting. Sensitivity to noise or light. If they have balance problems. If they’re feeling tired, like they have no energy. If they’re moody and irritable, sad, emotional, nervous, anxious.

If they’re having difficulty sleeping, either having, you know, wanting to sleep more or not sleeping enough or having trouble sleeping. Those are all triggers for you to know that there’s the possibility that there is a traumatic brain injury that needs to be followed up on. So if you’re the patient or if you are a family or friend of a patient, there are some things you need to do under those circumstances.

One, and this, by the way, is, there are a number of reasons why you’re doing it, you know, certainly to get the proper medical attention. But also if you do have an underlying injury claim, you want to make sure that you are properly documenting everything.

So one of the things you want done is to journal what’s going on with the patient, the difficulties that the patient is experiencing. This can be, you know, simply on a pad of paper. It can be typed. It doesn’t have to be. It can be done by the patient or it can be done by a family or friend who’s monitoring the patient.

Certainly you want to follow up with your primary care provider to make sure that he or she is getting you the proper medical attention and that proper medical attention is often going to start with a referral to a specialist. Normally, the first specialist you would see with a traumatic brain injury is going to be either a neurologist or a neurosurgeon. You know, for instance, if there’s a hematoma or something along those lines, that needs to be addressed surgically.

Sometimes along the treatment profile, you’re going to see there’s a need for physical therapy, occupational therapy, sometimes if it’s pronounced problem, you may need speech and language pathologist to get involved, recreational therapist, vocational therapist to help reintroduce a patient to the the ability to work and make a living.

Often when someone is going through a traumatic brain injury, they suffer from depression. They’re, they’re frustrated. They are confused. They don’t understand what’s going on or why. So they might need to see a psychiatrist or psych, psychologist or another therapist or counselor along those lines.

If they have those vision problems that we mentioned, obviously, they might need to see an ophthalmologist. Sometimes someone like a nutritionist might be worth speaking to. Certainly a physiatrist might be helpful in order to to to monitor all of the treatments and make sure there’s one source, that can be the family doctor or can be as someone separate, who is monitoring all of the treatment providers.

And then certainly once the treatment is secured, the proper treatment to address the underlying problems, in order to indicate what kind of cognitive or behavioral problems that the patient has gone through, you might need to see a neuropsychologist who can document any losses along those lines. For that reason it’s also helpful that perhaps school transcripts, prior psychological testing, IQ tests, things like that, those are great to have so that a baseline can be established from what the patient was like before the accident and now what they’re facing as as far as cognitive and behavioral losses as a result of the injuries from the accident.

So that’s all, those are all things that should be secured and monitored, you know, as the patient is treating. In addition, there are some danger signs that you have to be mindful of because in rare cases, dangerous blood clots can arise that crowd the brain against the skull and develop issues that might need emergency attention. So if you, if you as the patient, you begin to get a headache that gets worse and doesn’t go away right away, that’s something that you might want to be wary of.

Weakness, numbness or decreased coordination, repeated vomiting and nausea, especially if it’s after the first few days. Slurred speech, looking drowsy, not being able to wake up, having one pupil in the middle of the eye larger than the other. Certainly if you’re having convulsions or seizures, if you can’t recognize people or places, you get more confused, you get more agitated. Any unusual behavior. Certainly if you lose consciousness, any of those situations would require getting medical attention right away.

In addition to medical attention and legal attention, there are a lot of support groups available to those who have suffered a TBI. For instance, The Brain Injury Association of America. So simply look online for one of those near you because there are a lot of them available and they are extremely useful for those people who are suffering those frustrations.

I hope this information was useful. As always, please be sure to follow or subscribe to Legal Squeaks for free on your favorite podco, podcast platform.

You can suggest topics or guests at legalsqueaks.com.

Also, check out our other podcast, Uncommon Convos.

Please join us next week for another episode of Legal Squeaks.

And in the meantime, have a great day. Stay safe. And I love you all.

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