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Primary vs. Secondary Brain Injuries

Experienced Brain Injury Attorney serving Nationwide

What is Primary and Secondary injury? – Primary Brain Injury is, simply put, the damage which has occurred at the moment of the accident. Tissue and blood vessels are stretched or torn and the result is obvious. A skull fracture – where the bone is broken – is considered a primary brain injury.

Primary Brain Injuries: Skull fracture

The most common primary brain injury is a skull fracture, where the skull bones are cracked and perhaps penetrated. Since they are flat bones and contain no marrow, the skull gives way directly to brain matter in a fracture. That fracture often immediately injures the brain inside.

Secondary Brain Injuries

But many people who die as a result of brain injury do not do so immediately. A large percentage of those with TBI die days or even weeks after the injury. In fact, nearly 40% of brain injury patients who are not hospitalized will die some time after the event due to secondary brain injury. In secondary injury, a complex process of cellular degeneration and deterioration occur. Secondary deterioration may start immediately or may take a few days to begin.

Secondary injuries common to TBI victims are:

  • Free Radical Overload
  • Neurotransmitter Glutamate
  • Subarachnoid Hemorrhage
  • Hypoxia
  • Edema

Free Radical Overload

A free radical is either an ion, a molecule or an atom that has what are called “dangling” bonds. The upshot is that these bonds allow the highly chemically reactive ions to change when they come into contact with other dangling ions, molecules or atoms. Free radicals are important in that they change and eventually control vascular tone and blood pressure. But free radicals play an important role in a number of biological processes that occur within the brain, such as the intracellular killing of bacteria. Essentially, free radicals police cells within the brain. In an injury, they can change and harm proper brain function.

Probably the most important free radicals are based on oxygen, and when they are altered, they can become hyperactive, which can result in cell damage. Excessive amounts of free radicals can lead to cell injury, which may contribute to stroke and death. Free radicals are linked to Parkinson’s disease, senility, Alzheimer’s disease and schizophrenia. Movement disorders, psychosis, deafness, among other ailments are also possible with free radical overload. These are often triggered by a traumatic brain injury.

Neurotransmitter Glutamate

Glutamate is derived from amino acids from our diet that control certain synapses in the brain. In other words, the brain functions autonomously via these substances that vary the reactions in the brain. Their function is varied and quite complex. To sum up the problem, when the glutamate level in the brain changes – specifically, when it rises – it can lead to what is called excitotixicity, which essentially over-stimulates the brain. That can cause cell death and lead to stroke, seizures or eventual death. It can also be a leading cause of epilepsy, Alzheimer’s disease, Parkinson’s disease and Huntington disease.

Subarachnoid Hemorrhage

Subarachnoid hemorrhage is a bleeding in the subarachnoid space, which is the space between the pia mater and the arachnoid membrane as a result of a blunt head trauma. Symptoms of a subarachnoid hemorrhage usually begin with a very rapid and very serious headache that often comes on within minutes – with the possibility of the victim both vomiting and undergoing seizures. Although many subarachnoid hemorrhages are caused by stroke, they are also cause by head injury as well.

The classic subarachnoid hemorrhage is often fatal, with up to half of those afflicted ending in mortality. The symptoms of this dangerous condition are often loss of papillary light reflexes – meaning the pupils don’t dilate or contract correctly; or possible bleeding into the eyeball is present. With this onset, the body will often try to compensate and blood pressure will increase, which exacerbates the injury. Immediate medical attention is required, and subarachnoid blood can be detected on a CAT scan in most cases. Obviously, subarachnoid hemorrhage usually occurs near the site of the traumatic injury so diagnosis of the location of the injury is typically straightforward.


Hypoxia occurs when the brain is deprived of adequate oxygen. Mountain climbers are often afflicted by hypoxia. But hypoxia also occurs in a traumatic brain injury when the brain is not able to get enough oxygen through a disruption in blood flow. The symptoms of a mountain climber and a person who was struck in the head and has a traumatic injury are the same: they will have nausea, confusion, disorientation, behavioral change, headaches, possible hallucinations and a reduced level of consciousness.

Since tissue needs oxygen, and oxygen is infused into the blood through the lungs and heart, the problem may be as a result of a cascade of afflictions or as a result solely of a blunt-force trauma that affect one area – the brain. The specific problem is actually labeled ischaemia, or insufficient blood flow to brain tissue (or other tissues in other parts of the body). Problems can also arise when the cells in the brain are starved for oxygen and they eventually convert themselves to lactic acid, which will eventually lead to cell death and permanent brain damage.


There are various forms of edema – vasogenic, hydrostatic, high-altitude, among others — but the focus here will be what is known as vasogenic edema. Vasogenic edema is a breakdown of the junctions which constitute the blood-brain barrier. Certain proteins and fluid end up penetrating the blood-brain barrier and cause an inflammation of the brain itself. This can not only be a fast-acting affliction, but it is quite dangerous and needs immediate intervention. A second type of trauma can also occur, called cytotoxic edema, in which case the blood-brain barrier remains intact, but cellular degeneration occurs as a result of trauma and impairment of the function of sodium and potassium balance eventually leads to sodium retention and, like any sodium retention, the brain swells. Typically, cytotoxic occurs with vasogenic edema, and cytotoxic edema is typical after an injury.

Common Problems

In addition, brain injuries often occur in combination with one another. The effects of brain injury depend upon the amount of brain tissue damaged and the level of pressure within the skull and its effects on the brain.

Some of these may problems may be medically alleviated. Financially, however, it will likely be a difficult process. Any relief from the situation will likely be critical. Having an attorney with a focus in brain injury litigation is critical in providing you the opportunity to get the financial compensation you deserve. You will not pay a thing unless you win your lawsuit. If you win or settle your lawsuit, The Doan Law Firm will charge a percentage of the compensation amount, leaving you free from the costs of the actual court case.

The Doan Law Firm can assist in determining damages owed you after a brain injury. The Doan Law Firm knows that although accidents don’t wait for daylight hours to happen. However, we’re available to answer your phone contact us any time, day or night, at(800) 349-0000.

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