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Coup-Contrecoup Brain Injuries: Symptoms, Definition, and Treatment

Doctor showing patient mri scan of her coup-contrecoup brain injuries

Coup-contrecoup brain injuries are injuries that occur on both the side of the trauma and the opposite side of the brain.

Because they affect multiple areas of the brain, coup-contrecoup injuries are one of the most serious types of traumatic brain injury.

This article will teach you the causes and symptoms of contrecoup brain injuries as well as how to treat them.

Definition and Causes of Coup-Contrecoup Brain Injuries

The terms coup and contrecoup are French for “blow” and “counterblow.” Therefore, a coup-contrecoup injury actually refers to two separate injuries:

  • A coup injury which occurs directly under the point of impact.
  • A contrecoup injury which occurs on the opposite side of the brain from where the blow struck.

These injuries can occur separately, but if the blow is strong enough they will usually appear together.

The most common causes of coup-contrecoup injuries are:

  • Falls
  • Blunt force trauma
  • Automobile accidents
  • Sports injuries

Coup-contrecoup injuries are considered focal brain injuries: injuries that occur in a particular portion of the brain.

How Does a Coup-Contrecoup Injury Occur?

Man calling first aid after car crash, bandange on forehead because he has coup-contrecoup brain injuries


Because the brain is a fragile organ comprised of soft, fatty tissue, it has many layers of protection, including the skull and spinal fluid that surrounds it.

 In other words, the brain is essentially floating inside the skull. Normally, this provides enough protection from the many bumps and jolts that most of us experience throughout the day.

However, if the force of a blow or movement is too high, the brain can slam against the bony protrusions of the skull, causing serious damage.

Most coup-contrecoup injuries occur when the person’s head slams against a stationary object, like a steering wheel. When the skull hits the object, the brain moves forward until it collides with the front of the skull.

Then, because it was hit so hard, it actually bounces off the front of the skull and strikes the back, causing a second impact.

Coup-Contrecoup Brain Injury Symptoms

Because of the nature of coup-contrecoup injuries, the damage often affects the frontal, occipital, and/or parietal lobes.

In addition, if the blow occurred on the side of the head, both sides of the temporal lobe may become damaged

As a result, contrecoup brain injury symptoms can look a lot like the symptoms of these types of injuries.

1. Frontal Lobe Damage Symptoms

man rubbing forehead while sitting in doctor's office

The frontal lobe takes up the largest area of the cerebral cortex. It is responsible for higher cognitive skills, such as attention, planning, memory, and behavior.

Thus, a coup-contrecoup injury that damages the frontal lobe may affect these skills. Some symptoms include:

  • Impulsivity
  • Memory loss
  • Concentration problems
  • Aphasia
  • Behavioral and personality changes
  • Poor problem-solving and initiative

Damage to the frontal lobe may also cause motor problems such as weakness and paralysis.

2. Parietal Lobe Damage Symptoms

The somatosensory cortex is located in the parietal lobe. This, therefore, makes the parietal lobe responsible for processing sensory information.

If a contrecoup injury occurs on the parietal lobe, it may cause problems with sensation and perception. Some common symptoms include: 

Parietal lobe damage may also cause difficulties with writing, called agraphia.

3. Occipital Lobe Damage Symptoms

blurry image of living room, example of one of the contrecoup brain injury symptoms

The occipital lobe, located in the back of the brain, includes the visual cortex and is primarily responsible for visual functions.

 Symptoms of occipital lobe damage after a coup-contrecoup brain injury involve vision and perceptual deficits.

The most common symptom involves different types of blindness and visual distortions, such as:

  • Partial blindness (hemianopsia)
  • Word blindness (alexia)
  • Difficulty perceiving more than one object at once (Balint’s syndrome)

Finally, damage to the visual cortex may cause total blindness.

4. Temporal Lobe Damage Symptoms

The temporal lobe is located in the lower middle part of the brain, next to your temples, above your ears. Its main responsibility is processing sound. It also plays a role in interpreting smell and sight.

Some effects of temporal lobe damage include:

In addition, contrecoup brain injuries that damage the temporal lobe may also affect a person’s selective attention, resulting in a person having difficulty with concentration in a distracting environment.

For example, they would not be able to focus on a private conversation when in a loud, crowded room, or study while music is playing.

5. Other Symptoms

Besides these specific symptoms, coup-contrecoup brain injuries may also cause additional physical problems. These include:

Consequently, if you have any of these symptoms, You may be developing a dangerous hematoma, which requires immediate medical attention.

Treating Coup-Contrecoup Brain Injuries

Immediate treatment for coup-contrecoup brain injuries may involve monitoring of vital signs for forewarning of any life-threatening complications. The results of your MRI and tests may determine treatment options.

For example, if the injury only caused mild bruising, you will be sent home to rest. After a few days, you may gradually return to your normal activities, per recommendations from your Doctor.

However, if the injuries were more severe, treatment may follow the same course as other types of brain injury. You will need to focus on activating your brain’s neuroplasticity, which may allow you to regain function.

The following are effective therapies to help you do this:

  • Physical and occupational therapy. These therapies can help you recover muscle strength and coordination after a coup-contrecoup injury.
  • Speech therapy. If your injury resulted in aphasia, you may lose your ability to communicate. A speech therapist teaches you how to regain language skills.
  • Cognitive training. This training may improve memory, attention, problem-solving, and learning skills.

The CT Speech & Cognitive Therapy App provides both speech therapy and cognitive therapy. Best of all, it’s available in the app.

These are a few of the therapies and treatments that may help you overcome the effects of coup-contrecoup brain injuries. Talk to your therapist for more recommendations.

Coup-Contrecoup Brain Injuries: Key Points

Coup-contrecoup brain injuries may cause problems in multiple areas of the brain, on both the site of impact and on the opposite side. They are caused by sudden acceleration and deceleration of movement.

Although these injuries look different, treatment may remain the same as other types of brain injury. By activating neuroplasticity through targeted therapies, patients may begin to decrease some of the effects of coup-contrecoup injuries.

Featured Image: ©iStock/Chinnapong

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