Suffered a Coup Contrecoup Injury? Our Firm Can Help
Coup Contrecoup (“coo-contra-coo“) results in a traumatic brain injury (TBI) that occurs somewhere other than the initial site of the head strike. Studies have shown that a coup contrecoup type of injury is one of the most underreported as a result of a personal injury incident.
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Coup Contrecoup Resources in This Article:
- What is a Coup Contrecoup Injury?
- Symptoms of Coup Contrecoup Head Injuries
- Severity & Prognosis Following Coup Contrecoup Injuries
- Rehabilitation from a Coup Contrecoup Injury
- Compensation & Liability For Coup Contrecoup Injuries
What is a Coup Contrecoup Injury?
Coup contrecoup means “blow [and] counterblow.” In general, it refers to a traumatic brain injury that occurs somewhere other than the initial site of a hit to the head. A classic case of coup contrecoup would involve being struck on the forehead, but sustaining a brain injury at the back of the brain as a consequence. A simple coup injury typically occurs when a mobile object strikes an immobile head, whereas contrecoup is more likely to occur when a mobile head strikes an immobile object.
There are multiple theories for the exact causes of contrecoup injuries, due to the failure of any one explanation to account for all such instances. However, there is consensus that the brain possesses the ability to move within the skull and even press itself against the inside of the jagged skull during inertia or sudden acceleration and deceleration.
Another generally accepted mechanism is because the brain is less dense than the cerebrospinal fluid (CSF) which surrounds it, meaning that the relatively lighter brain is more likely to move away from a coup region of impact, while the denser CSF fluid moves towards the region of impact. Thus the moving brain is less likely to be cushioned by CSF fluid than it would be under normal circumstances. For this reason, cerebral contusions or brain bruises caused by contrecoup are often more severe than the injuries sustained at the initial impact site.
Symptoms of Coup Contrecoup Head Injuries
Coup contrecoup resulting in a traumatic brain injury can give rise to a constellation of symptoms. Some of these symptoms are specific to the brain regions affected by the impact, while others are more general. The seriousness of coup contrecoup necessitates that a thorough evaluation be conducted for all suspected coup and contrecoup injuries.
General Symptoms
The symptoms of a traumatic brain injury due to coup contrecoup include headaches, lightheadedness, memory deficits, disorientation, light sensitivity, difficulty concentrating, social isolation, anxiety, and depression.
Headaches
Post-traumatic headaches are common following a TBI. The type of headache can vary greatly and can persist for life.
Memory Loss
TBI-caused memory loss is also common and usually affects short-term more than long-term memory. A common memory issue one experiences is “remembering to remember,” also called prospective memory, such as recalling that you need to return somebody’s call in the next day or two. However, it can also manifest as forgetting the contents of recent conversations, the location of items like keys or phones, or generally losing track of time.
Loss of Consciousness
A mild TBI can result in a brief loss of consciousness. More severe TBIs can cause a person to fall into a coma — a prolonged period of loss of consciousness.
Slurred Speech
Slurring one’s words, among other speech-related symptoms such as dysfluent or unintentionally repetitious speech, is another symptom of a TBI. In serious cases such as dysarthria, the slowed and slurred speech makes it difficult for the victim to be understood by others. Speech impairments can profoundly impact a person’s quality of life.
Sensitivity to Light
A general sensitivity to light may occur after suffering a TBI.
Symptoms by Brain Region
Coup contrecoup injuries can be localized resulting in varying symptom profiles depending on the specific sites of the brain injury.
Frontal Lobe
Damage to the frontal lobe of the brain may cause weakness to one side of the body or face, increase the risk of falling, reduce creative and problem-solving abilities, disrupt the senses (such as taste and smell), change behavior and mood, reduce attention span, and result in greater risk-taking.
Temporal Lobe
Injury to the temporal lobe can cause epilepsy, aphasia (speech disorder), changes in personality and self-image (especially as they relate to emotional and interpersonal interactions), and alter behaviors (such as how quickly or powerfully one experiences hunger, thirst, and sexual desire). It can also affect spatial navigation and reasoning, such as those required to drive and navigate.
Parietal Lobe
Trauma to the parietal lobe can affect visual and academic aspects of consciousness, such as causing difficulty with drawing objects, distinguishing left from right, reading, problem solving, spatial orientation, and planning and executing complex tasks.
Occipital Lobe
Disruption to the occipital lobe can cause visual issues, such as the ability to locate objects or identify specific colors or words.
Severity & Prognosis Following Coup Contrecoup Injuries
Coup contrecoup injuries can negatively impact one’s life for months or even years. All forms of traumatic brain injuries may cause substantial pain, suffering, and even death, and are associated with high healthcare costs.
In this section:
- Levels of Severity of Coup Contrecoup Injuries
- Impairments That Can Arise Following a Coup Contrecoup Injury
- Complications That Can Result From Coup Contrecoup Injuries
- How Can Coup Contrecoup Injuries Impact Quality of Life?
- Are Contrecoup Injuries More Severe Than Coup Injuries?
Levels of Severity of Coup Contrecoup Injuries
TBIs, including those caused by coup contrecoup, are measured by numerous factors, including the Glasgow Coma Scale (GCS) and neuropsychological testing.
Impairments That Can Arise Following a Coup Contrecoup Injury
Milder cases of coup contrecoup may involve headaches, brief blackouts, light sensitivity, and negative effects on one’s mood or senses. Moderate and severe cases may be accompanied by more long-term or permanent deficits such as memory loss, epilepsy, slurred speech, depression, and difficulty with reasoning.
Complications That Can Result From Coup Contrecoup Injuries
Severe cases can cause life-threatening and debilitating complications such as coma, paralysis, and/or life-long seizures.
Coma
A TBI may cause the victim to fall into a coma, which is a period of lengthy and deep unconsciousness. This may occur especially when a hematoma (blood in the brain) or other obstructions are causing elevated pressure in the head. In general, the severity of a coma can be determined by its length and depth, meaning not only how long it persists, but also the degree to which the person exhibits the symptoms.
Paralysis
Unlike with spinal cord injuries, paralysis due to a TBI occurs because the areas of the brain that communicate with the body have been damaged. In addition to total or partial paralysis, this kind of damage can also manifest as milder symptoms such as spasticity (tight muscles) and dysphagia (trouble swallowing).
Seizures
Seizures may occur immediately after one suffers a TBI, but they can also happen months or years later, such as when a person develops epilepsy. Seizures that happen as a direct consequence of the TBI are often referred to as “post-traumatic.”
How Can Coup Contrecoup Injuries Impact Quality of Life?
TBIs caused by a coup contrecoup mechanism of injury can fundamentally alter one’s quality of life. Even when a TBI does not cause death or coma, it may be accompanied by a host of newfound challenges to one’s cognition, mobility, and physical/mental resilience. All of these challenges may have a profound impact on a person’s quality of life, making them dependent on others for care and support.
Are Contrecoup Injuries More Severe Than Coup Injuries?
It is possible for the injuries to the contrecoup site to be greater than those caused at the initial coup site. For example, while there may be no observable injury at the initial site, the brain at the secondary site may be bruised, bleeding, or suffer axonal shearing.
Rehabilitation from a Coup Contrecoup Injury
The rehabilitation following a coup contrecoup injury may require various forms of treatment. Unfortunately, such treatments are often expensive.
How Expensive is Treatment for a Coup Contrecoup Head Injury?
The initial medical costs associated with a TBI can range from a few thousand dollars to over a half-a-million dollars. The lifetime cost for such treatment and care are well into the millions of dollars.
Types of Therapies & Treatments of Coup Contrecoup Injuries
The ongoing symptoms of coup contrecoup injuries may necessitate post-hospital therapies such as speech therapy, cognitive training, rehabilitation, psychotherapy, and occupational therapy.
Speech Therapy
Speech-language pathologists can assist TBI patients in strengthening their voice usage and language comprehension.
Cognitive Training
Cognitive training involves a wide spectrum of brain-strengthening practices which may or may not be overseen by a medical professional or therapist. Such training may include problem solving, map drawing, memorizing and recalling lists, solving puzzles, or counting numbers.
Brain Rehabilitation
Brain rehabilitation is a broad term for therapies and rehabilitation that may begin in the hospital and continue for the rest of a person’s life. These may include mental and physical exercises, vocational rehabilitation, and neuromuscular exercises (cutting-edge mobility and motor control treatments). Usually a physiatrist assists in quarterbacking the type of treatment needed.
Compensation & Liability For Coup Contrecoup Injuries
Our team stands ready to help you or your loved one get the compensation and closure they deserve in the aftermath of a coup contrecoup injury. For more information on the implications of a brain injury, visit our brain injury page.
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Banner image from Unsplash
ARTICLE BY
ARMEN AKARAGIAN
Admitted to practice in 2006, Armen has arbitrated, tried, and settled several cases which have resulted in multi-million dollar verdicts and settlements.
Sources cited in this article:
- Coup Contrecoup Brain Injuries – Verywell Health
- Coup and Contrecoup Injury: Definition & Symptoms – Study.com
- Traumatic Brain Injury – Johns Hopkins Medicine
- Contrecoup Brain Injury – NIH
- Coup Contrecoup Injury – ScienceDirect
- Coup contrecoup injury – Wikipedia
- Headaches After Traumatic Brain Injury – MSKTC
- Memory and Traumatic Brain Injury – MSKTC
- Prospective Memory – ScienceDirect
- Traumatic Alterations in Consciousness: Traumatic Brain Injury – NIH
- Glossary of Neurological Terms: Coma – NIH
- Post-concussion Syndrome Light Sensitivity: A Case Report and Review of the Literature – NIH
- Frontal Lobe Brain Injury – Physiopedia
- Temporal Lobe – Physiopedia
- Aphasia – Mayo Clinic
- Parietal Lobe – Physiopedia
- Occipital Lobe – Physiopedia
- Medical Care Costs Associated with Traumatic Brain Injury over the Full Spectrum of Disease: A Controlled Population-Based Study – NIH
- What Are the 8 Main Types of Traumatic Brain Injury? – Flint Rehab
- Coma After Acute Head Injury – NIH
- Hematoma – NIH: National Cancer Institute
- Coma and brain injury – Synapse
- Brain Injury Paralysis Recovery: Treatments and Techniques to Help Regain Mobility – Flint Rehab
- Glossary of Neurological Terms: Spasticity – NIH
- Dysphagia – Mayo Clinic
- Preventing Epilepsy – CDC
- Epilepsy – World Health Organization
- TBI-QOL: Development and Calibration of Item Banks to Measure Patient Reported Outcomes Following Traumatic Brain Injury – NIH
- Traumatic brain injury – Mayfield
- In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment – NIH
- Speech Therapy – Cleveland Clinic
- What Is Cognitive Training and Does It Work? – Verywell Mind
- Simple, low-cost, low-tech brain training – Harvard Health Publishing
- Brain Rehabilitation – Mayo Clinic
