Coup and Contrecoup Injuries: The Brain Trauma That You Can’t See


Any time an object strikes the head, the brain is at risk for traumatic brain injury. These injuries are serious, and can lead to both short-term and long-term health effects. But many people don’t realize the seriousness of TBI or the kind of damage that it can cause. Understanding this injury is the first step to doing something about it.

Though TBI can be caused by physical contact – a blow to the head, or striking the head on a hard surface – serious brain trauma can occur even if there is no visible injury to the head. Physical force that causes the brain to ricochet within the skull can cause what’s called a coup contrecoup brain injury. The brain is different from other organs of the body in that it is not fixed in place. Suspended in cerebrospinal fluid, the brain is vulnerable to sudden bodily movements. With enough force or movement, the brain can easily sustain injury in not one, but two places. An injury to the brain at the point of impact is called a coup injury. When that initial blow forces the brain to move within the skull and strike against the side of the skull opposite the blow, this second brain injury is called the contrecoup.

Causes of coup contrecoup brain injury

Coup injuries typically occur when a moving object strikes the head. But a coup-contrecoup injury is usually characterized by the movement of the head stopped by a fixed object, according to the Brain Injury Association of America. These circumstances can occur when the head jerks violently during motor vehicle accidents or falls. Sports offer additional scenarios where the brain is at risk of a coup contrecoup injury. Baseball players colliding during the chase for a fly ball, football players tackling, and boxers punching all readily come to mind as sports examples that can lead to coup contrecoup injury. But any sport that puts the head at risk of suffering a blow could cause this type of brain injury.

Coup contrecoup injuries can occur even without physical contact. All that is needed is for the head to move forcefully, causing it to come into contact with the skull. The whiplash effect on the head caused by a car crash and the sudden movement of the head from a fall can cause this brain movement, even if the head does not ultimately strike against a hard object.

TBI is a contributing factor to approximately 30 percent of all injury deaths in the United States, according to the Centers for Disease Control and Prevention. Most TBIs, including coup contrecoup injuries, are caused by falls. From 2006 through 2010, the most recent figures available from the CDC, falls accounted for 40 percent of these injuries, leading to visits to the emergency room, hospitalization, and in the worst cases, death. The youngest and the oldest are most susceptible to falls, the CDC noted. Unintentional blunt trauma, such as being struck by an object, was the second leading cause of TBI. Car crashes were the third-leading cause of TBI; assaults were fourth.

Watching for signs of traumatic brain injury

If you experience a head injury, the CDC says that signs to watch out for include headaches; blurry vision; nausea or vomiting; and sensitivity to light. Other signs of head injury include changes in mood or behavior, as well as changes in sleep patterns.

The bruising of brain tissue caused by a head injury is called a contusion, Brainline explains. Damage to nerve cells in the brain, which leads to a breakdown of the ability for neurons to communicate, is called diffuse axonal injury. In more serious coup contrecoup injuries, heavy bleeding, called a hematoma, can occur. This bleeding can lead to brain damage.

With no open and visible wounds, it’s easy to dismiss any pain from a head injury as just a simple headache. But coup contrecoup injuries are serious and they’re not the kind of injuries that can be resolved by taking an over-the-counter pain killer. If not diagnosed and treated, the brain injury can worsen over time. Secondary effects of brain injury can emerge hours or days after the initial trauma, Scientific American explains. These secondary effects could include brain damage and cognitive difficulties. Furthermore, if you have already experienced a head injury, your brain could be more susceptible to injury again. Repeated blows to the head are thought to lead to chronic traumatic encephalopathy, a degenerative condition of the brain. While this diagnosis can only be confirmed by examining the brain after death, the symptoms of this disease include memory loss, dementia, and erratic behavioral changes, according to the Mayo Clinic. This condition is still being researched and right now, there is no cure.

Your health and legal options for a head injury

If you have experienced head trauma due to some sort of accident, such as a motor vehicle collision or a fall, there is a chance that you experienced a coup contrecoup brain injury. Remember that serious injury to the brain can happen even when you do not strike your head against something. It’s also important to note that you should seek medical attention as soon as possible. A physician can provide the diagnosis and treatment that you need. Furthermore, the documentation of your medical condition becomes important information for your legal case, if you wish to pursue a claim. Contact us to learn more about your legal options regarding a coup contrecoup brain injury.