Traumatic Brain Injury

What Is a Coup-Contrecoup Brain Injury? Causes, Diagnosis, and Your Michigan Claim

October 15, 2026

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What Is a Coup-Contrecoup Brain Injury? Causes, Diagnosis, and Your Michigan Claim

Summary

A coup-contrecoup injury happens when a violent impact causes the brain to strike one side of the skull, then rebound and hit the other. This guide explains the causes, why a standard CT scan can miss the damage, and how Michigan no-fault and pain and suffering claims work for these injuries.

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A coup-contrecoup injury is one of the most serious forms of traumatic brain injury (TBI). It happens when a violent impact injures the brain in two places at once: where the head was struck, and on the opposite side. These injuries often follow car accidents, truck crashes, motorcycle crashes, and falls, and they are frequently underdiagnosed in the emergency room.

Below, our Michigan brain injury lawyers explain how coup-contrecoup injuries happen, why they are easy to miss, and what they mean for your claim.

What Is a Coup-Contrecoup Injury?

A coup-contrecoup injury occurs when a forceful impact causes the brain to strike one side of the skull (the coup), then rebound and strike the opposite side (the contrecoup). Because the brain is injured at both points, bruising (contusions), bleeding, and lasting neurological damage can develop on opposite sides of the brain.

Coup vs. Contrecoup: What Is the Difference?

Coup injury: damage at the site of impact, directly beneath the point where the head struck an object such as a steering wheel, window, or the ground.

Contrecoup injury: damage on the opposite side of the brain, caused when the brain rebounds and collides with the other side of the skull. In falls and other sudden-deceleration injuries, the contrecoup damage is often more severe than the damage at the impact site.

The difference matters in a lawsuit. The location of each injury can help show how the crash unfolded, which direction the force came from, and that the injury is consistent with the accident rather than a prior condition. That can be important when an insurance company disputes how you were hurt.

Can You Get a Coup-Contrecoup Injury Without Hitting Your Head?

Yes. The brain can move violently inside the skull even when the head never strikes anything. In a rear-end or high-speed crash, rapid acceleration and deceleration, the same motion behind whiplash, can drive the brain into the front and back of the skull. A concussion can happen the same way. For a broader overview of brain injury types, see our guide: What Is a Traumatic Brain Injury?

How Is a Contrecoup Injury Diagnosed?

Imaging matters enormously in these cases. A standard emergency room CT scan is good at finding skull fractures and larger bleeds, but it can miss contrecoup damage and smaller injuries entirely.

Advanced MRI sequences, such as susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI), are far more sensitive. They can reveal tiny bleeds and damage to the brain’s nerve fibers (axonal injury) that a CT does not show. A neuropsychological evaluation can also measure changes in memory, attention, and processing speed.

If your ER visit included only a CT scan and you are still having symptoms weeks later, ask your doctor whether an MRI or neuropsychological testing is appropriate. These records often become key evidence in a brain injury claim.

Common Causes of Coup-Contrecoup Injuries in Michigan

The faster and more violent the impact, the greater the risk. Common causes include:

High-speed and rollover car accidents
Semi-truck crashes, where the size difference creates extreme force
Motorcycle accidents, even when the rider wears a helmet
Slip and falls, especially backward falls on ice or hard floors
Sports and recreational injuries

Symptoms of a Coup-Contrecoup Injury

Because two areas of the brain are injured, symptoms can be mixed and confusing. Damage to the front of the brain may affect personality, judgment, and focus, while damage to the back may affect vision. Common signs include headaches, dizziness, blurred vision, memory problems, sensitivity to light and noise, and sudden mood changes.

Get emergency care right away for a worsening headache, repeated vomiting, confusion, unequal pupils, slurred speech, or seizures. These can signal bleeding or swelling in the brain. For a full symptom list, see What Is a Traumatic Brain Injury?.

Long-Term Effects

Coup-contrecoup injuries can cause lasting memory loss, sensory loss, and loss of motor function. In severe cases, patients may be left comatose or paralyzed. Even moderate injuries can affect work, relationships, and independence for years. Learn more about long-term head injuries.

Compensation for a Coup-Contrecoup Injury in Michigan

After a Michigan motor vehicle crash, your no-fault (PIP) insurance pays medical bills, lost wages, and other benefits, including care from neurologists and neuropsychologists, regardless of who caused the crash. If a negligent driver caused your injury and it seriously affects your ability to live your normal life, you may also be able to recover pain and suffering from the at-fault driver’s insurance.

To see what affects the value of a brain injury case, read our Michigan TBI car accident settlement guide. For a full explanation of no-fault benefits, see our Michigan Car Accident Lawyer Guide.

Frequently Asked Questions

Is a contrecoup injury worse than a coup injury?

It can be. In falls and sudden-deceleration injuries, the damage on the opposite side of the brain is often more severe than the damage at the impact site.

Can a CT scan miss a contrecoup injury?

Yes. CT scans can miss small bleeds and nerve-fiber damage. Advanced MRI sequences such as SWI and DTI are more sensitive.

Can I get a coup-contrecoup injury if my head didn’t hit anything?

Yes. Rapid acceleration and deceleration in a crash can move the brain inside the skull hard enough to injure both sides.

Can I recover pain and suffering for a coup-contrecoup injury in Michigan?

Possibly. If another driver was at fault and the injury seriously affects your ability to live your normal life, you may have a claim for pain and suffering in addition to your no-fault benefits.

Talk to a Michigan Brain Injury Lawyer

The Michigan brain injury lawyers at the Lee Steinberg Law Firm have represented clients with coup-contrecoup brain injuries for decades. We understand the medicine behind these injuries and help clients and their families pursue every no-fault benefit and the full pain and suffering compensation the law allows.

For a free consultation, complete our online form or call 1-800-LEE-FREE. There are no fees or costs unless we win your case.

About

Eric Steinberg

Eric Steinberg is a managing partner at the Lee Steinberg Law Firm, having recovered tens of millions for clients throughout Michigan. Attorney Steinberg has almost 20 years of experience handling personal injury, auto accidents, big truck accidents, premises liability, medical malpractice, nursing home injury, and dog bite cases.

He is one of Michigan’s leading authorities on personal injury law, having served as the President of the Michigan Association for Justice (MAJ).  As an advocate for ensuring people have access to justice, Attorney Steinberg believes all injured individuals should be able to obtain legal representation at their most difficult times. As a result, all clients at his firm never pay an attorney fee or any costs until the outcome of their case is successful.  Attorney Steinberg has tried multiple cases to verdict and handles all facets of the Lee Steinberg Law Firm. He has been named a Michigan Super Lawyer by his peers as one of the top personal injury attorneys in the State of Michigan. Attorney Steinberg is also a frequent speaker at seminars where he teaches other lawyers about updates in personal injury law, discovery tactics, and trial advocacy.

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