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Traumatic Brain Injury:  Coup And Contrecoup Brain Injuries Explained

Traumatic Brain Injury: Coup And Contrecoup Brain Injuries Explained

Last week, I read a page on another law firm’s website asking, What You Should Know About Car Accidents And Brain Trauma. The title peaked my interest! But, the article really disappointed. Like so many other lawyer pages, it was mostly a long list of different types of accidents and different medical conditions. Short on substance! Stuffed with key words to capture search traffic! It worked – I stopped and clicked. The article provided no real information and suggested the reader call the lawyers. I’d rather have a real discussion with some real answers.

I’ve written several past articles discussing specific traumatic brain injury (TBI) topics, including the evaluation, treatment and presentation of these injuries. You can find many of my prior articles on this blog. My goal is to provide helpful information. So, I thought I would write today about a specific type of brain injury:  Coup-Contrecoup Injuries. Many people have never heard those terms. But, these injuries are common in serious accidents.

What Are Coup-Contrecoup Brain Injuries?

Coup and contrecoup refer to specific types of head injuries. What are they? The terms coup and contrecoup are French for “blow” and “counterblow.” It’s probably easier to think of these injuries in familiar English terms. Both coup and contrecoup injuries are considered “focal brain injuries.” That is, they are injuries which occur in a particular spot within the brain. But, the two injuries occur in very different areas.

A coup injury (pronounced coo) refers to brain damage directly under the spot of impact. Think of these injuries like this — The patient suffers a blow to the head and then has a brain injury at that spot.

A contrecoup injury refers to brain damage on the opposite side of the brain from where the impact occurred. For example, the patient impacted the front of his head but the brain injury occurred in the back of his head.

Coup and contrecoup injuries can occur individually. In other words, you can have one without the other. But, they often occur together. When they do occur together, patients can suffer a much broader range of problems because more than one area of the brain has been impaired.

What Common Accidents Cause Coup-Contrecoup Injuries?

Once you learn the basics of these injuries, the types of accidents causing them make much more sense. Let’s think about a direct impact to the head. When a moving object hits a stationary head, a coup injury is typically the result. For example, you are standing still when an object flying through the air hits your head. In these cases, the injury is typically at the area of impact.

When a moving head strikes a stationary object, a contrecoup injury also frequently occurs. Contrecoup injuries often involve a sudden deceleration of the head – a moving head strikes a stationary object. This is why serious car accidents often cause contrecoup injuries. In a car crash, the vehicle may suddenly and abruptly stop. But, the occupant’s head continues forward until striking the steering wheel or dashboard.

Even in the absence of an impact, you can suffer TBI. Think about a severe whiplash from being rear-ended with a forceful impact. In those situations, a person’s had may suddenly and violently be thrust backward. After violently going backward, it will usually bounce back forward. The person suffered no outside impact but their brain forcibly moved within their skull. Whether a car crash is a front-end, side-impact, or rear-end collision, a driver or passenger can suffer violent force propelling their head into motion. You can suffer internal brain injury from the forceful movement.

The most common causes of contrecoup injuries are falls and car accidents. In both cases, the victim suddenly and forcefully stops upon impact. According to Centers For Disease Control (CDC) statistics, falls lead to almost half of all TBI-related hospitalizations. And, motor vehicle crashes are also one of the most common causes of TBI. So, potential contrecoup injuries are very common. In many cases, the severity of the injury at the contrecoup site is even greater than that occurring at the impact (or coup) site.

Medical researchers have several different theories as to how the forces within a person’s head cause specific injury opposite to the impact. The brain contains soft tissue enclosed by surrounding fluid and the skull. When a person’s head is slammed in one direction suddenly, the brain can initially slam forward and then slam backwards in the other direction. By searching “contrecoup” on Youtube, you can easily find a number of animations and videos demonstrating these injuries.

What Problems Can A Coup-Contrecoup Injury Cause?

In past articles, I’ve written about the lack of medical diagnosis and treatment of brain injuries. Initial diagnosis is a huge issue. Within the emergency room, patients with head trauma may initially appear fine. TBIs are often referred to as “invisible injuries” because patients look normal. Plus, emergency rooms are often focused on patients with the most glaring, potentially fatal issues. So, emergency personnel may overlook obvious TBI symptoms. In other brain injury situations, the symptoms may evolve or progress over a period time following the accident. So, symptoms may not even be present in the emergency room. Finally, many patients deny their own TBI symptoms. Many people find it very difficult to admit these problems. Because of all these reasons, many TBI patients leave the emergency room undiagnosed.

TBI’s are frequently overlooked. Within the medical community, many professionals lack the training or expertise to evaluate and treat brain injuries. They are often misunderstood. I’ve seen many cases where physicians ignored clear TBI symptoms. But, even a TBI classified medically as “mild” can cause permanent impairments.

Coup-contrecoup injuries can also be more difficult because they impact two separate regions of the brain. Because of this, the patient may suffer a wider range of problems than anticipated. Since the injury is within the skull and not visible, medical professionals may not understand some of the symptoms. We just completed a vehicle rollover case here in Huntsville where the seriousness of the TBI was completely ignored by emergency room staff but later proved disabling.

In some of my prior articles, I specifically discussed TBI symptoms and impairments. So, I won’t re-list them here. As I mentioned earlier, I don’t like lawyer articles that simply list key terms for search engines! Instead, I wanted to focus here on a specific TBI that often impacts people in traumatic accidents.

If you (or a loved one) are suffering symptoms of a possible TBI, seek out a skilled physician who can help with your rehabilitation and recovery. Keep in mind that many medical professionals lack TBI expertise. Do your research to find the right care for your recovery!


At the Blackwell Law Firm, we help people across Alabama following a serious personal injury. Our cases include traumatic brain injury claims as well as other serious personal injuries. Outside the courtroom, we continue to advocate for safer roadways, safer workplaces and safer products. If you have legal questions, let us know. Our consultations are always free and confidential.