Brain Injury Series Part 2: The Ways a Brain Can Be Injured

This is the second of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.

We first discussed the anatomy of the brain, including the structure of neurons.  Here we will discuss the ways that our brain can be injured and the implications that flow from the various kinds of injuries.

The brain is very delicate and is considered to be consistently similar to that of gelatin.  If a brain is suddenly jolted or banged or twisted, it will cause a traumatic impact that ripples through the entire brain and can cause complications.  The brain is made up of billions of neurons that can be damaged by trauma to a person’s head.

Some of the ways damage can occur to a human’s brain are as follows:

Mild Traumatic Brain Injury or Concussion

The term mild traumatic brain injury is used interchangeably with the term concussion.  A concussion is caused by a blow or jolt to the head that disrupts the function of the brain.  Unlike more severe traumatic brain injuries, the disturbance of brain function from a concussion is caused more by dysfunction of brain metabolism rather than by structural damage.  The current understanding of the neuropathophysiology of a mild TBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events.  After an impact causing a concussion, there is an increase in glucose metabolism, and then a subsequent reduced metabolic state.  These events interfere with the neuronal function in the brain and may lead to cell death after the injury.

Diffuse Axonal Shear

In a diffuse axonal shear injury, many of the nerve cell pathways (axons) may be torn apart or stretched. This can cause a loss of connection between brain cells and can lead to a breakdown of overall communication among neurons in the brain. Information processing may be disrupted.  A diagram demonstrating the process of axonal shear appears below:

Coup – Contre-Coup

A coup contre-coup injury to the brain occurs when there is a sudden impact to the head, which causes the brain to first slam into one side of the skull wall, then bounce off that wall and slam into the wall on the opposite side of the skull.  The coup injury to the brain occurs at the site of initial impact. The contre-coup injury to the brain occurs when it hits the opposite side of the skull.  An illustration showing this mechanism of injury is depicted below.

Hemorrhage and Swelling

An injury that causes bleeding within the brain can also damage brain cells.  Bleeding is caused when the blood vessels within the brain have been damaged.  An injury to the brain which causes bleeding is different than an injury to the ankle.  If you were to trip and sprain your ankle badly, you could tear muscles, ligaments, or blood vessels. The swelling created by the bleeding and fluid accumulation would cause more serious problems which is why we apply ice or cold compresses to the ankle. The brain reacts in a similar fashion, except our skull is not flexible like the skin on our ankle to handle the swelling. The brain bleeds and swells within itself causing further injury.

The important point here is that the blow or insult to the brain is only part of the problem.  Bleeding and swelling injures the internal neural network and is often pervasive and not just localized at the site of initial impact.

Some individuals may be lucid for an interval following an impact to the head.  They will then experience a deteriorating level of consciousness.  This can be indicative of a head injury involving bleeding. Below is a diagram depicting the differences between a normal brain and a swollen brain:


Anoxia occurs from the decrease in oxygen to the brain.  When oxygen levels are significantly lower for four minutes or longer, brain cells begin to die.  In a motor vehicle collision, this can occur if a person’s airway is obstructed.

It is important to understand the mechanisms of how the brain can be injured and the resulting effects that a client will experience.  The next blog in the Winning Strategies for Handling a Mild to Severe Brain Injury Case Series will discuss the difficulties a lawyer faces when representing an individual who has suffered a traumatic brain injury.  Subsequent blogs will discuss ways these challenges can be overcome. 


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