Are there different types of TBI?

Other than by organic, non-traumatic causes, brain injuries are caused by sudden traumas. Every brain injury is different, but there are two basic types: open head injuries and closed head injuries.

Open head TBIs are graphic and gory. The origin of the injury could be a bullet wound, knife penetration, a baseball bat impact, or a high-speed collision, the outcome is usually bloody and extreme. The femoral artery, one of the largest arteries in the body, constantly provides blood to the brain and head. Stretched tightly over the skull, the scalp tends to bleeds profusely if it is cut. If the skull is cracked or pierced, fragments of bone can get lodged in the brain. Since the brain is comprised of layers of soft, permeable tissue, it is difficult, sometimes impossible, to extract broken bone fragment or foreign objects that may become lodged in the tissue. For these reasons, brain surgery is very risky and extremely complicated.

In a closed head injury, although nothing actually penetrates the skull, the damage that results is often every bit as severe as an open head injury, sometimes even more so. Since the skull is not broken one may assume closed head injuries produce less severe injuries. That is an incorrect assumption. In closed head injury, pressure builds up and damages brain tissue. If you fracture the skull, you may let off excess pressure thus saving the brain from further damage.

During a closed head injury, a sudden, direct force, such as the impact from a baseball bat or striking a steering wheel, may be applied against the skull (Direct Impact, or Coup). That force causes the skull to come in direct contact with the brain. The same impact may cause the head to “snap back and forth” causing the brain to strike the skull on the opposite side of the initial impact (Secondary Impact, or Contrecoup). Other causes of Secondary Impact could be the result of whiplash or striking ones head against a wall. It is not uncommon that there could be both a Coup and Contrecoup injury from a single impact.

The most common type of closed head injury is a concussion — a strong blow from an external force. If a person’s head is whipped around, a small tearing effect called shearing occurs throughout the brain, resulting in a diffuse axonal injury. Axons are the hair-like extensions of nerve cells that transmit messages, so in a diffuse axonal injury, the messages either get mixed up, or they don’t come through at all. The three primary injuries that result from a closed head injury are Bruising (bleeding), Tearing and Swelling.


If a person is driving a car at 55 miles per hour and strikes another car traveling at a similar speed, the person’s brain goes from 55 miles per hour to zero in less than a second. The soft tissue of the brain, due to inertia, continues to travel at a high rate of speed, slamming against the hard bone of the skull. The brain tissue is compressed and distorted against the skull and that force may cause blood vessels to tear. If blood vessels tear, they will release blood into areas of the brain in a rapid and erratic way.

Why does bleeding in the brain present such a concern to medical professionals? The greatest concern is that there is only so much space in the skull and there is no room for this extra blood. The skull is unable to expand to accommodate the extra blood because it is hard and brittle. As a result, the blood exerts pressure on everything inside the skull, including soft, pliable brain tissue. Brain tissue is soft and delicate and can easily stop functioning properly or may even die off. In the event there is any bleeding in the brain, the pressure will make critical areas of the brain cease functioning. Any areas that control important bodily functions, such as breathing or heart rate could be impacted, and a potentially fatal condition may develop within hours of the accident. It is not uncommon for people that have sustained a head injury from a car accident to exhibit no negative effects immediately after the accident. In less than an hour, they may begin to become more and more confused and eventually lapse into a coma. That is the primary reason why Emergency Medical Technicians at the scene of the accident advocate people going to a hospital following a car accident.


In a car accident, the brain may be propelled forward, then snapped backward. In this forward/backward motion, the brain can be torn. The brain can also be torn by the effects of “energy”. If you take a block of ice and hit it with a hammer (assuming you don’t completely shatter the ice), you will see little cracks in the ice. Energy from the hammer has been transferred to the ice, producing the web-like cracks. Tearing in the brain is very serious. Tearing in the brain “cuts” the wires that make the brain work.

One of the problems with tearing is that it happens on a microscopic level (the brain has about 100 billion of these “wires”). This tearing may not show up on typical medical tests. Devices that take pictures of the brain will not see these small tears. Two common ways of viewing the brain are with a CT Scan (using X-rays) and an MRI (using magnetic fields) to create pictures of the brain. Both of these techniques are very good at seeing blood and tumors in the brain, but they are not good with tears (which are very small). In a number of medical studies with people who have head injuries, only 10 to 15 percent had “positive” CT Scans or MRI findings.


If a heavy object is dropped on your toes, your foot will turn “black and blue” where the heavy object landed due to blood leaking under the skin. Your foot does something else—it swells up. As a defense mechanism, your body knows your foot has been injured and sends blood to heal the injured toes. If your brain is struck your body does the same thing. The problem is, there is no extra room for the blood in your skull and the pressure begins to build up. This pressure pushes against the brain and damages cells in the brain. Excessive pressure can stop important components that control breathing or the heart rate. This may necessitate a doctor installing a intra-cranial pressure monitor or ICP to let off the excess pressure and return the brain’s pressure to a less dangerous level.
If you have been involved in an accident that resulted in a TBI or spinal column injury, the injury and necessary treatment can be overwhelming. The rights and benefits you may be entitled to can be equally unclear. You need the advice and counsel of an attorney that has experience with TBI and spinal injuries, is aggressive and not afraid to fight with the insurance company to secure everything you deserve. Dan Newlin & Partners are such attorneys. Call Dan Newlin & Partners for a free consultation and learn about the complex area of the law surrounding TBI and spine injuries. Insurance companies have attorneys whose job it is to give you as little as possible to settle your injury claim. You need an attorney by your side to help you receive all the compensation you are entitled to for your medical bills, pain and suffering. Please call Dan Newlin & Partners right away at (407) 888-8000. You will be glad you did.