Traumatic Brain Injuries and Head Injuries

What Are Traumatic Brain Injuries and Head Injuries?

A traumatic brain injury (TBI) occurs when a sudden blow, jolt, or penetrating injury to the head disrupts normal brain function. Head injuries encompass any trauma affecting the scalp, skull, brain, or underlying tissue and blood vessels in the head. The brain is a delicate organ, and even seemingly minor impacts can cause serious damage.

These injuries are classified as either closed or open. A closed head injury means the skull remains intact, though the brain inside may still be severely damaged through bruising, bleeding, and swelling. An open head injury occurs when an object penetrates the skull and enters the brain tissue. Closed injuries aren’t necessarily less serious than open ones—in fact, they can cause devastating brain damage.

When your brain strikes the inside of your skull or is violently shaken, it can bruise tissue, tear blood vessels, damage nerve fibers, and disrupt the chemical processes that allow your brain to function. Because the brain controls everything your body does—movement, speech, memory, emotions, and basic bodily functions—damage to any part of it can have far-reaching effects.

How Brain and Head Injuries Occur

• Motor vehicle accidents – Car crashes, truck collisions, and motorcycle accidents are leading causes of traumatic brain injuries. The violent forces involved can cause your head to strike the steering wheel, window, or dashboard, or can whip your head back and forth so forcefully that your brain slams against your skull. In 2020 alone, over 2.1 million emergency room visits resulted from vehicle accident injuries. High-speed crashes, drunk driving incidents, and distracted driving accidents often result in the most severe brain trauma.
• Motorcycle accidents – Motorcyclists face even greater risk because they lack the protective barrier of a vehicle. Even when wearing a helmet as required by California Vehicle Code Section 27803, riders can suffer serious brain injuries in collisions. The impact of hitting the pavement or being struck by another vehicle can cause catastrophic head trauma requiring immediate medical intervention.
• Truck accidents – Commercial trucks have significantly more mass and weight than passenger vehicles, making collisions with 18-wheelers and tractor-trailers especially dangerous. The force of impact in these accidents often results in severe traumatic brain injuries to occupants of smaller vehicles, as well as to pedestrians, motorcyclists, and cyclists.
• Slip and fall accidents – Falls are a major cause of brain injuries, especially among older adults and on construction sites. Slipping on wet floors, tripping on uneven surfaces, or falling from heights can result in your head striking concrete, tile, or other hard surfaces with tremendous force.
• Workplace accidents – Construction workers, industrial employees, and others who work at heights or around heavy machinery face significant risks of head injuries from falls, falling objects, and equipment accidents.
• Pedestrian accidents – Being struck by a vehicle often causes severe head trauma when victims are thrown to the pavement or hit their heads on the vehicle.
• Sports and recreational injuries – Contact sports, cycling accidents, and other recreational activities can cause concussions and more serious brain trauma.
• Assaults and violent acts – Physical attacks, including being struck with objects, can cause skull fractures and brain damage.

Types of Brain and Head Injuries

Concussions – The most common type of traumatic brain injury, concussions occur when impact causes the brain to move rapidly inside the skull. This can result in temporary loss of consciousness, confusion, and altered awareness. While often called “mild” traumatic brain injuries, concussions can have serious lasting effects, especially when multiple concussions occur. Symptoms include headaches, dizziness, confusion, memory problems, and sensitivity to light and noise. Even “mild” concussions can cause lasting problems with memory, concentration, balance, and mood.

Skull fractures – These occur when the skull bone breaks from impact. There are four main types:

Linear skull fractures are simple breaks in the bone without displacement. They’re the most common type and often heal without surgical intervention, though they still require careful monitoring.

Depressed skull fractures occur when pieces of broken skull press inward toward the brain. These typically require surgery to lift the bone fragments and relieve pressure on the brain.

Diastatic skull fractures are widening of the skull sutures (joints between skull bones), often seen in newborns and young children whose skull bones haven’t fully fused.

Basilar skull fractures are breaks at the base of the skull and are the most serious type. They often cause cerebrospinal fluid to leak from the nose or ears and can damage critical nerves and blood vessels.

Brain hemorrhage – Uncontrolled bleeding inside the brain that can cause rapid deterioration, stroke, and death if not treated immediately. This is a medical emergency requiring immediate intervention.

Intracranial hematomas – Collections of blood inside the skull that put dangerous pressure on the brain. When a ruptured blood vessel causes blood to accumulate inside the skull, this creates pressure that can be fatal without emergency surgical intervention. There are several types:

Epidural hematomas occur between the skull and the outer protective layer of the brain. They often result from skull fractures that tear blood vessels and require emergency surgery.

Subdural hematomas develop between the brain and its protective covering. They can be acute (developing rapidly) or chronic (developing slowly over weeks). Both types are serious and often require surgical drainage.

Intracerebral hematomas are bleeding directly within brain tissue. These are particularly dangerous and can cause severe, permanent brain damage.

Contusions and coup-contrecoup injuries – Bruising of the brain tissue itself, usually at the site of impact (coup injury). A contrecoup injury occurs on the opposite side when the brain rebounds and strikes the other side of the skull. These occur when the force of impact causes the brain to strike the front of the skull at the point of impact, then rebound and hit the back of the skull. This creates two sites of injury and can cause extensive damage. Severe contusions may require surgical removal of damaged tissue.

Diffuse axonal injury (DAI) – One of the most severe types of TBI, DAI occurs when the brain shifts so rapidly inside the skull that nerve fibers (axons) are torn throughout the brain. This disrupts communication between brain cells and often results in coma, severe disability, or death.

Scalp lacerations – Deep cuts to the scalp can bleed heavily and may indicate more serious underlying injuries. They require proper cleaning and closure to prevent infection.

Warning Signs and Symptoms

Brain injury symptoms can appear immediately or develop over hours or days following the trauma. Some symptoms are obvious, while others are subtle and may be dismissed as stress or fatigue. Never ignore head injury symptoms—what seems minor can become life-threatening.

Symptoms of mild to moderate brain injury include confusion or disorientation, headaches that persist or worsen, nausea and vomiting, dizziness or loss of balance, blurred vision or sensitivity to light, ringing in the ears, fatigue or drowsiness, difficulty concentrating or remembering, mood changes or irritability, anxiety or depression, and sleep disturbances.

Symptoms of severe brain injury requiring emergency care include loss of consciousness for more than a few minutes, seizures or convulsions, persistent and severe headaches that don’t improve, repeated vomiting, clear fluid draining from the nose or ears (cerebrospinal fluid leak), dilated pupils or unequal pupil size, slurred speech or inability to speak, profound confusion or combativeness, weakness or numbness in the arms or legs, loss of coordination or inability to walk, increasing restlessness or agitation, severe drowsiness or inability to wake up from sleep, and coma.

If you or someone you know experiences any symptoms of severe brain injury, seek emergency medical care immediately. Even seemingly mild symptoms should be evaluated by a doctor, as some brain injuries worsen over time and delayed treatment can result in permanent damage or death.

Long-Term Impact of Brain Injuries

The effects of a traumatic brain injury can last a lifetime. Even after the initial injury heals, many TBI survivors face ongoing challenges that affect every aspect of their lives.

• Cognitive impairments – Difficulty with memory, concentration, problem-solving, and processing information. Many people struggle to return to work or school. Simple tasks that once came naturally become frustratingly difficult.
• Physical disabilities – Weakness, paralysis, loss of coordination, chronic headaches, seizures, vision or hearing problems, and increased susceptibility to additional brain injuries. Some victims require assistive devices or modifications to their homes.
• Emotional and behavioral changes – Depression, anxiety, mood swings, irritability, impulsiveness, aggression, and personality changes that strain relationships. Family members often say their loved one is “not the same person” after a brain injury.
• Communication difficulties – Problems with speech, language comprehension, reading, and writing can make it hard to express yourself or understand others.
• Loss of independence – Many TBI survivors require ongoing assistance with daily activities and may never be able to live independently again. This loss of autonomy is emotionally devastating.
• Increased vulnerability – Brain injury survivors are more susceptible to additional injuries, develop dementia earlier, and face higher risks of psychiatric disorders.

The medical costs are staggering. TBI patients often require emergency surgery, extended hospitalization, rehabilitation, ongoing therapy, medications, assistive devices, and sometimes lifelong care. Lost wages, reduced earning capacity, and the need for home modifications add to the financial burden. The emotional toll on families—watching their loved one struggle with permanent disabilities and personality changes—is equally profound.

Compensation for Brain and Head Injuries

California law allows brain injury victims to seek three types of damages:

• Economic damages – These compensate for measurable financial losses including emergency medical treatment, hospitalization and surgery, neurological care and monitoring, prescription medications, rehabilitation and therapy (physical, occupational, speech), assistive devices and equipment, home and vehicle modifications, lost wages, loss of future earning capacity, and ongoing care expenses that may extend for a lifetime.
• Non-economic damages – These address the profound impact on your quality of life including physical pain and suffering, emotional distress and mental anguish, cognitive impairment and loss of mental capacity, personality changes and behavioral problems, loss of enjoyment of life, loss of consortium (impact on relationships), and permanent disability.
• Punitive damages – In cases involving particularly reckless conduct—such as drunk driving or intentional harm—California courts may award punitive damages to punish the wrongdoer and deter similar behavior. There are no caps on punitive damages in California, though they must be reasonable under the Due Process Clause of the Fourteenth Amendment.

Brain injury cases typically involve substantial damages because the medical care required is extremely expensive and the injuries often result in permanent disability. Insurance companies know this, which is why they fight these claims aggressively.