Coup injuries occur at the point of impact.

• A. At the point of impact
• B. On the opposite side of the skull
• C. In the spinal cord
• D. In the neck muscles

Answer: (A)

Coup injuries occur at the site of impact because the brain is abruptly accelerated and collides directly with the inner surface of the skull where the blow lands, causing a focal contusion there. The brain’s inertia means it can continue moving after the initial impact and may produce a secondary injury on the opposite side of the skull, known as a contrecoup injury. So the injury you’d expect at the point of contact is coup. An injury on the opposite side would be contrecoup, not coup, and injuries to the spinal cord or neck muscles involve different traumatic mechanisms, not the brain contusion pattern described here.