Acquired Brain Injury (ABI) Overview

Acquired Brain Injury (ABI) Defined

An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. The injury results in a change in neuronal activity, which affects the physical integrity, the metabolic activity, or the functional ability of nerve cells in the brain. An acquired brain injury is an injury to the brain that occurs after birth, where it is presumed there was normal brain development and the injury to the brain was subsequently acquired.

Acquired brain injury (ABI) is an umbrella definition as it includes injuries caused by external physical forces applied to the head, as well as internal insults to the brain. All of the injury causes and pathologies you see in this chart are included as Acquired Brain Injuries.

Three Types of Acquired Brain Injury


Traumatic Brain Injury (TBI)/Traumatic Impact Contact Injury

A traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. With traumatic impact injuries the head is struck by an object or an object strikes the head resulting in either a:

  • Open (penetrating) injury
  • Closed injury

An open head injury is a penetrating brain injury involving a breach of the skull or breach of the meninges (so that an object penetrates the skull and enters the brain). This type of injury often results in focal injuries (such as epidural or subdural hematomas, or intracerebral hemorrhage). With penetrating injuries (such as a gunshot wound) a major complicating factor can be secondary infection due to the skull/meningeal breach.

Open Head Injury


Closed head injuries are focal or diffuse non-penetrating brain injuries. They can cause brain lacerations and contusions, or intracerebral hemorrhage within the brain causing focal injuries.

Traumatic Inertial Non-Contact Injury

Traumatic inertial injuries are non-impact injuries resulting from inertial forces.

One type of closed head traumatic inertial injury is the coup-contrecoup injury. Contusions or lacerations may occur directly beneath the point of impact (coup) and then occur contralateral (opposite side) to the site of impact (contrecoup).

The graphic above shows the head/brain moving forward (linear acceleration) and then striking an object (with rapid linear deceleration of the brain), resulting in frontal lobe focal lesions (this is coup); moving to the right in this graphic, you’ll see the rebound where the head/brain move backwards striking an object causing occipital lobe focal lesions (this is the contrecoup).

Animated Version of a Coup – Contrecoup Injury

Diffuse Axonal Injury (DAI)

With these types of closed head injuries, there can also be more diffuse injury resulting from tearing or shearing of axons, known as a diffuse axonal injury (DAI). DAI is the most common form of damage to the brain structure, resulting from axonal shearing (axons are twisted or disconnected) inhibiting neuron – to – neuron communication.

Animation of Diffuse Axonal Injury (DAI)

Non-Traumatic Brain Injury/Internal Insult

Non-traumatic brain injuries include stroke, neurotoxic poisoning, hypoxia and anoxia, among others. Hypoxia and anoxia include a lack of oxygen that causes brain cells to die. When they die, they release chemicals that can cause further damage to the brain.

Neurotoxin Examples

  • ethanol
  • lead
  • mercury
  • DDT
  • arsenic
  • manganese
  • fluoride
  • carbon monoxide