Reviewed by Larry Forman, Attorney.
Key takeaways: A coup contrecoup injury bruises the brain in two places: at the point of impact and on the opposite side. Because a coup contrecoup injury can affect several brain areas, symptoms and recovery can vary a lot. Below, we cover how a coup contrecoup injury happens and the 10 Rancho recovery levels doctors use.
A coup contrecoup injury is a brain injury at two sites: where the head was struck and on the opposite side of the brain. These injuries are common in car crashes because the brain moves inside the skull when the body stops suddenly.
What is a coup contrecoup injury?
- Coup: the injury at the point of impact.
- Contrecoup: the injury on the opposite side, when the brain rebounds and strikes the other side of the skull.
Contrecoup injuries often affect the frontal and temporal lobes, which control attention, memory, mood, and judgment. That is why someone can look fine but act differently after a crash. A head doesn’t have to hit anything; the rapid acceleration and deceleration in a crash can be enough.
Symptoms to watch for
Headaches, confusion, memory problems, sleep changes, irritability, light or noise sensitivity, and dizziness. Symptoms can show up hours or days later. See head injury symptoms after a car accident and concussion after a car accident.
Stages of TBI recovery: the Rancho Los Amigos scale
Rehabilitation teams often track recovery from moderate to severe TBI with the Rancho Los Amigos Levels of Cognitive Functioning:
- Level I: no response (total assistance).
- Level II: generalized response (total assistance).
- Level III: localized response (total assistance).
- Level IV: confused, agitated (maximal assistance).
- Level V: confused, inappropriate, non-agitated (maximal assistance).
- Level VI: confused, appropriate (moderate assistance).
- Level VII: automatic, appropriate (minimal assistance for daily living skills).
- Level VIII: purposeful, appropriate (stand-by assistance).
- Level IX: purposeful, appropriate (stand-by assistance on request).
- Level X: purposeful, appropriate (modified independent).
Source: StatPearls, Rancho Los Amigos (NIH National Library of Medicine). The original scale had eight levels; the revised scale added levels IX and X.
Recovery is not a straight line, and many people with mild TBI never fit neatly into these stages. For more, see the NINDS and CDC TBI pages.
What this means for an injury claim
Brain injuries are often under-valued because they don’t show up on X-rays, and sometimes not on a CT scan. Documentation matters: emergency records, neurology follow-up, neuropsychological testing, and statements from family about changes. Long-term needs may call for a life care plan. Louisville’s trauma care options are listed in Louisville trauma centers.
Most Kentucky car crash claims have a two-year deadline (KRS 304.39-230(6)); other injury claims generally have one year (KRS 413.140(1)(a)).
How Forman & Associates helps
We work with treating doctors and neuropsychologists to document the full effect of a brain injury. Learn more on our traumatic brain injury lawyer page. Larry Forman has 13 years of experience representing injured Kentuckians, and you pay no fee unless we win.
Coup contrecoup injury FAQ
What causes a coup contrecoup injury?
A sudden impact or rapid deceleration that makes the brain strike the skull at the point of impact and then the opposite side, as often happens in car crashes.
Can a coup contrecoup injury happen without hitting your head?
Yes. Violent acceleration and deceleration, such as in a rear-end crash, can move the brain inside the skull without a direct blow.
How long does TBI recovery take?
It varies widely. Many mild TBIs improve over weeks to months, while moderate to severe injuries can take years and may cause lasting effects.
What is the Rancho Los Amigos scale?
A scale rehabilitation teams use to describe stages of cognitive recovery after brain injury, from no response (Level I) to purposeful, appropriate behavior (Levels VIII–X).
Talk to a Louisville brain injury lawyer
If you or a family member has changed since a crash, talk with us. Get a free case evaluation or call (502) 931-6788. Our office is at 1139 S. 4th St., Louisville.
This post is general information about Kentucky law, not legal advice. Every case is different.
