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By Expert ID: 6049, Ph.D.

Closed head injury is an extremely frequent occurrence in personal injury cases. According to the CDC, in the United States approximately 1.4 million individuals suffer from this type of trauma each year. By far, the predominant cause of traumatic brain injury is accidents involving motor vehicles and falls.
 
Symptoms from closed head injury often cause extreme distress and continued disability in victims. Cognitive symptoms due to closed head, traumatic brain injury can include impaired attention, slowed thought processes, difficulties with self expression, impaired memory, and problems with planning and organizing.  Physical symptoms often include chronic headaches, dizziness, tinnitus, light and sound sensitivity. Closed head injury also often results in psychological problems, including depression, anxiety, and even changes in personality. 
 
Two types of injury are likely: diffuse axonal injury and coup contre coup injury. Briefly, diffuse axonal injury involves the shearing of neurons due to rapid deceleration and rotation of the brain during an accident. This mechanism of injury causes poor communication of different parts of the brain and slowed overall brain functioning.
 
Coup contre coup injury occurs when deceleration causes the brain to move within the skull and to impact the inside of the skull.  Coup refers to the initial impact of the brain against the interior of the skull. Contre coup refers to the rebound of the brain against the opposite, or contra-lateral, side of the skull.  If severe enough, coup contre coup injury can result in contusions of brain tissues.  This tends to occur when the brain comes into contact with areas of the skull that have bony protrusions.  Severe cognitive and psychological deficits can result.
 
Most lay persons are unaware of the fact that traumatic brain injury can occur even when there is no impact of the head against a surface.   For example, in a car accident in which there is impact to the victims’ torso but no impact to the head, coup contre coup injury (as well as diffuse axonal injury) can occur. The skull  decelerates abruptly upon impact.  However, the brain, floating within the tight confines of the skull, decelerates only once it has been pushed into the skull.  Thus, even when there is no bruising to the head and no report by the individual of having hit their head, traumatic brain injury can arise. 

Neuropsychologists are trained to administer a standardized, medically and forensically sound battery of tests in order to quantify the degree of symptoms and of impaired functioning. While it is obvious that clients should be referred for a neuropsychological evaluation when they report having hit their head or when medical reports demonstrate bruising of the head, it is less obvious to refer clients for an evaluation when neither is in evidence. Given that injury to the brain can occur without impact to the head, referral for a comprehensive neuropsychological evaluation is advisable just the same.   In this case, an astute attorney will often be the catalyst to have his client evaluated. 

By Expert ID: 6049, Ph.D.