How Traumatic Brain Injuries are Classified: Open vs. Closed Head | Direct Head Injury | Hypoxia

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In this video attorney Joe Lamb discusses the mechanics of brain injuries and how they are classified. Each one has a different level of severity and a different level of treatment that can be used. This is why it's always so important to get treated by a medical professional after a serious head injury.

The first distinction within the mechanics of a brain injury is open versus closed head injury. Open head injuries account for about 25% of TBIs. Open head injuries can be broken down even further into penetrating, perforating, and tangential injuries. Penetrating occurs when an object penetrates through the skull and remains in the brain. Bullets are a very common example of this. If it remains lodged in the brain, that's penetrating. Perforating occurs if the bullet were to come through the head leaving an entry and an exit wound. And then a tangential injury is if a baseball were to hit the head and were to crack the skull and cause an injury. This causes the actual skull fragments themselves to go into the brain. So, penetrating goes in and gets lodged, perforating goes all the way through, and tangential cracks the skull, and then pieces of the skull become lodged in the brain.

Closed head injuries account for the other 75% of all brain injuries. These are the most common form of head injuries and what we often talk about when we refer to concussions and other TBIs. The two categories of these are direct and indirect, direct being what most people consider a blunt force and indirect being coup contrecoup injuries, or an acceleration/deceleration injury.

A direct head injury is probably the most straightforward, closed head injury there is. Typically speaking if you get punched in the head, this is the type of head injury you're gonna have. An indirect impact occurs when you've got the actual brain hitting the inside of the skull itself. This type of injury occurs when the head moves forward really quickly and then backward. Your brain is hitting the front inside of your skull and then hitting the back of it. This is commonly called a coup contrecoup injury. And the coup is the first injury and the contrecoup is the second. So, when the head goes forward and the brain hits the front of the skull, that's the coup, and then when it falls back and it hits the back of the skull, that's the contrecoup. This is most commonly seen in car accidents because it's a whiplash-style injury.

Hypoxia is another type of indirect brain injury. This essentially means there was a loss of oxygen to the brain. Some common ways that this occurs are strokes, carbon monoxide poisoning, and excessive smoke inhalation. This can cause the failure of oxygen to get to the brain tissues. And it's just as much a brain injury as the others, but as you can see, very different in terms of the mechanics of how it occurs in that there's no physical motion, there's no direct injury, there are no skull fragments, a lot quieter and less gruesome, but equally as dangerous because strokes, carbon monoxide poison, and smoke inhalation kill thousands of people each year. In fact, strokes are one of the leading causes of death in people over the age of 65.