Two Primary Types of Brain Injuries

Brain injuries can affect one area of the brain, multiple areas of the brain or the brain as a whole, depending on which parts of the brain sustained the most damage. No two accidents or injuries are exactly the same, and the type and extent of damage from a brain injury can vary dramatically. The two primary types of brain injuries are traumatic brain injuries and acquired brain injuries.

Traumatic Brain Injuries

When external force is applied to the skull by either a violent jolt or blow to the head, it can result in traumatic injury to the brain. As reported by the CDC, there were more than two and a half million traumatic brain injuries (TBIs) in the United States in a recent year. While many of the TBIs occurred as a result of a direct injury to the head, sustaining a TBI in conjunction with another type of injury is not uncommon. If you or a loved one has sustained a traumatic brain injury, it will fall into one of the following categories:

Concussion Graphic


Any injury to the head or brain is traumatic and can be capable of causing substantial damage. Individuals who have sustained concussions often require only observation and may require little treatment and not need extensive rehabilitation or surgery. There are cases that may necessitate additional or long-term treatment programs, depending on the extent of the injury and damage.

A concussion is the most common type of TBI and can be caused by a whiplash type injury from an auto accident, a blow to the head, a gunshot wound, violent shaking of the head, an open or closed head injury or other type of impact. Not all people with TBI will experience a loss of consciousness. Some may simply feel dazed and confused. Concussions do not always present on a CAT scan or other type of diagnostic imaging test. This type of injury can result in intracranial swelling, blood on the brain or blood clots. Most concussions cause only temporary damage and recovery can be achieved in as little as a few months.

Contusions in the brain


A contusion is a rupturing of blood vessels resulting in bleeding on the brain. Contusions are primarily caused by a direct impact to the head. In severe cases, a cerebral contusion may have to be surgically removed to prevent further damage from being caused.

Coup-contrecoup brain injury

Coup – Contrecoup

Coup-contrecoup is a term used to describe a traumatic brain injury resulting in a cerebral contusion both at the point of impact and on the opposite side of the brain. This type of TBI occurs when the impact of the blow is forceful enough to cause the brain to bounce back and forth inside the skull.

A diffuse axonal injury

Diffuse Axonal

A diffuse axonal injury is one of the more common types of traumatic brain injuries. It is also one of the most severe. If left untreated, a diffuse axonal closed head injury may result in death. One of the most common signs of a diffuse axonal injury is unconsciousness. The term diffuse describes the widespread damage that occurs from an axonal injury. In a diffuse axonal injury there will be excessive tearing of the nerve tissue in the brain. There also will be a temporary or permanent disruption of nerve cells, thus inhibiting the brain’s ability to communicate with the rest of the body. This type of injury can be seen in auto accidents, falls, domestic violence, Shaken Baby Syndrome, sports accidents and other similar head injuries.

Penetrated brain injury graphic


This type of TBI is self-explanatory in that it results from the penetrating impact of a knife, bullet or other sharp object. In this type of injury, the force of the impact can cause hair, skin, bone fragments and various contaminates to be lodged in the brain. When bullets or other objects bounce around within the skull, the damage to the brain can be extensive. These types of TBI often result in permanent damage or death.

Acquired Brain Injuries

Acquired brain injuries (ABI) differ from traumatic brain injuries in that these types of injuries are typically caused by injuries caused after birth, such as those stemming from a degenerative disease, substance abuse, strokes, tumors, oxygen deprivation, toxins, near drowning or infection. An ABI is not necessarily caused by a blow to the head.

Blood clot in the brain


Anoxia is a type of brain injury that occurs when the brain is completely deprived of oxygen for a period of time. This type of brain injury can be caused by a lack of oxygen, blood containing insufficient oxygen or toxins interfering with the body’s ability to effectively use the oxygen found in the blood.

Brain without enough oxygen


Hypoxic brain injuries are also caused by oxygen deprivation. In this type of acquired brain injury, oxygen is getting to the brain, but it is not enough to allow the brain to function in its usual capacity. Hypoxic brain injuries often occur when there is a dramatic drop in blood pressure or the flow of blood to the brain has been hindered.

What are the symptoms associated with each of the different levels of brain injury?

There are three levels of brain injury:

  • mild traumatic brain injury
  • moderate traumatic brain injury
  • severe brain injury.

The severity of an individual’s brain injury can be measured by the Glasgow Coma Scale (GCS), which is the standard scoring system used to determine the neurologic state of a recent head trauma victim.

  • A GCS score between 13-15 indicates a mild traumatic brain injury
  • A GCS score between 9-12 indicates a moderate traumatic brain injury
  • A GCS score below 9 usually indicates a severe brain injury

Individuals who sustain mild traumatic brain injuries will often experience a brief loss of consciousness, or at the very least feel somewhat dazed and confused. Tests and scans will usually appear normal. This may make diagnosis impossible until or unless the individual exhibits signs of altered brain functionality, as can be seen with concussions.

When an individual receives a violent blow to the head, or a vicious shaking, it may result in a moderate TBI. In these instances, unconsciousness could last anywhere from a few minutes to a couple of hours. Disorientation and confusion can be prolonged for weeks. Depending on the severity of impact, the victim of a moderate TBI may experience some level of physical, cognitive or behavioral deterioration on either a temporary or permanent basis.

Severe brain injuries are the most life-altering type of brain injuries commonly resulting in permanent, irreversible damage to the brain. This type of injury can lead to neurological defects, degenerative brain disorders and other long-term problems. Symptoms may include a long period of unconsciousness, comas, confusion, loss of memory and other symptoms. Deficits or difficulties involving cognitive, speech, sensory, perceptual, physical, social, emotional and other functions are extremely common. Most individuals who sustain severe brain injuries will never fully recover.

What are the signs of secondary brain damage?

Following a traumatic head injury, it is important that victims watch out for signs of secondary brain damage. Some of the most common signs of secondary brain damage are:

  • Swelling on the brain (edema)
  • Intracranial pressure
  • Seizures
  • Inexplicable fever
  • Changes in blood pressure
  • Anemia
  • Hematoma
  • Cardiac issues
  • Lung difficulties

Dizziness as a result of brain injuryWhat physical, cognitive and communication problems can I expect after a TBI?

A traumatic brain injury (TBI) can lead to a number of serious and life-altering problems. If you have sustained a TBI, these are some of the physical, cognitive and communication problems you can expect to endure:

Physical problems can include loss of hearing, headaches, seizures, dizziness, nausea, blurred vision and a decreased sense of smell or taste. An individual’s strength, coordination and ability to concentrate can also be affected.

Cognitive problems will often appear as an inability to concentrate (particularly when there are external distractions), difficulty processing new information, short-term memory loss, impulsive reactions or trouble carrying through tasks to completion.

Communications problems that may develop include an inability to stay on a particular topic of conversation, difficulty discerning sarcasm, trouble responding to non-verbal communications (facial expressions or body language) and problems keeping up in a conversation. Emotional outbursts are more common after a TBI as well.

Confusion as a result of brain injury

Cognitive problems will often appear as an inability to concentrate (particularly when there are external distractions), difficulty processing new information, short-term memory loss, impulsive reactions or trouble carrying through tasks to completion.

Communications problems that may develop include an inability to stay on a particular topic of conversation, difficulty discerning sarcasm, trouble responding to non-verbal communications (facial expressions or body language) and problems keeping up in a conversation. Emotional outbursts are more common after a TBI as well.

Treating Traumatic Brain Injuries

Receiving proper treatment after a TBI is essential to an individual’s recovery. Once emergency medical care has been completed, many doctors will employ a combination of treatment methods including medication, rehabilitation and in some cases, surgery.

Diuretics may be prescribed to help reduce pressure inside the brain. Anti-seizure drugs can significantly reduce an individual's chances of having a life-threatening seizure, particularly within the first few weeks following your injury. In cases where the TBI was sufficiently severe to require the patient be put into a coma, coma-inducing drugs may be administered.

Surgery can be beneficial in the removal of hematomas or cerebral contusions that have been putting pressure on the brain. Surgery can also be used to repair skull fractures or open a portion of the skull to release pressure and drain excess fluid.

Rehabilitation is the lengthiest portion of a TBI patient’s recovery program. The level of severity will determine what types of rehabilitation specialists a patient may be required to see, as well as how long treatment will need to be continued. Rehabilitation specialists can include psychiatrists, TBI nurse specialists, physical therapists, rehabilitation nurses, occupational therapists, neuropsychologists, speech and language pathologists, social workers and more.

Following through with a doctor’s recommended treatment plan will help dramatically reduce of the risk of secondary or further damage being caused to the brain. For information on additional services or specialized support, we recommend you check out our list of brain injury support resources.

Hawaii Brain Injury Lawyer: Trusted Legal Representation

Surviving a traumatic brain injury, or taking care of an individual who has sustained a traumatic brain injury, can be very difficult. Rest assured you are not alone. There are countless resources and support programs that you can access to help you along the way. Our firm is also here to provide you with trusted legal representation, particularly in cases where a TBI has been caused as a result of another person’s negligence or neglect. Leavitt Yamane & Soldner is Hawaii’s trusted injury law firm. Contact us now to find out what we can do for you.

Our Professionals Are Here to Listen

If you have sustained an injury and want to know if you are eligible to pursue legal action, it is important to obtain help right away. Call our firm at (808) 518-2120 or fill out the quick form below.

Send My Information