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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.

Today you will learn the causes and symptoms of contrecoup brain injuries and 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, i.e. injuries that occur in a particular spot on 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 made of soft, fatty tissue, it has many layers of protection, including the skull and spinal fluid that surrounds it.

This means that the brain is essentially floating around 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, they usually damage 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 could 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 most higher cognitive skills, such as attention, planning, memory, and behavior.

Thus, a coup-contrecoup injury that damages the frontal lobe can affect most of these skills and others. Some symptoms include:

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

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

2. Parietal Lobe Damage Symptoms

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

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

Parietal lobe damage can 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, is home to the visual cortex and is primarily responsible for visual functions.

Thus, symptoms of occipital lobe damage after a coup-contrecoup brain injury mainly involve vision and perception problems.

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 can cause total blindness.

4. Temporal Lobe Damage Symptoms

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

Some effects of temporal lobe damage include:

In addition, contrecoup brain injuries that damage the temporal lobe can also affect a person’s selective attention. This means they have more difficulty picking out one thing to pay attention to.

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 more specific symptoms, coup-contrecoup brain injuries can also cause more general, physical problems. These include:

Consequently, if you have any of these symptoms, get to the hospital immediately. You may be developing a dangerous hematoma.

Treating Coup-Contrecoup Brain Injuries

Immediate treatment for coup-contrecoup brain injuries will involve monitoring to make sure you have not developed any life-threatening complications. The results of your MRI and tests will determine treatment.

For example, if the injury only caused mild bruising, you will be sent home to rest. Then, after a few days, you can gradually return to your normal activities.

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

The following are a few of the best 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 caused aphasia, you can lose your ability to communicate. Fortunately, a speech therapist can teach you how to regain language skills.
  • Cognitive training. This training can help 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 on-the-go in the app.

These are only a few of the therapies and treatments that can 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 can 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.

Although these injuries look different, treatment will mostly remain the same as every other type of brain injury. By activating neuroplasticity through targeted therapies, patients can begin to reverse some of the worst effects of coup-contrecoup injuries.

Featured Image: ©iStock/Chinnapong

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