Traumatic Brain Injury

ExitCare ImageTraumatic brain injury (TBI) occurs when an injury to the head causes the brain to move back and forth. The risk of brain injury varies with the severity of the trauma. The damage can be confined to one area of the brain (focal) or involve different areas of the brain (diffuse). The severity of a brain injury can range from:

  • A blow or jolt to the head that disrupts the normal function of the brain (concussion).

  • A deep state of unconsciousness (coma).

  • Death.


A brain injury can result from:

  • A closed head injury. This occurs when the head suddenly and violently hits an object but the object does not break through the skull. Examples include:

  • A direct blow (hitting your head on a hard surface).

  • An indirect blow (when your head moves rapidly and violently back and forth like in a car crash). This injury is called countrecoup (involving a blow and counter blow). Shaken baby syndrome is a severe type of this injury. It happens when a baby is shaken forcibly enough to cause extreme countrecoup injury.

  • Penetrating head injury. A penetrating head injury occurs when an object pierces the skull and enters the brain tissue. Examples include:

  • A skull fracture occurs when the skull cracks or breaks.

  • A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. This can cause bruising of the brain tissue called a contusion.

In both closed and penetrating head injuries, damage to blood vessels can cause heavy bleeding into or around the brain.


The symptoms of a TBI depend on the type and severity of the injury. The most common symptoms include:

  • Confusion (disorientation) or other thinking problems.

  • An inability to remember events around the time of the injury (amnesia).

  • Difficulty staying awake or passing out (loss of consciousness).

  • Headache.

  • Blurry vision.

  • Vomiting.

  • Seizures.

  • Swelling of the scalp. This occurs because of bleeding or swelling under the skin of the skull when the head is hit.


Treatment of traumatic brain injury can involve a range of different medical options:

  • If a brain injury is moderate to severe, a hospital stay will be necessary to monitor:

  • Neurological status.

  • Pressure or swelling of the brain (intracranial pressure).

  • For seizures.

  • Severe brain injury cases may need surgery to:

  • Control bleeding.

  • Relieve pressure on the brain.

  • Remove objects from the brain that result from a penetrating injury.

  • Repair the skull from an injury.

  • Long term treatment of a brain injury can involve rehabilitation work such as:

  • Physical therapy.

  • Occupational therapy.

  • Speech therapy.


The outcome of TBI depends on the cause of the injury, location, severity, and extent of neurological damage. Outcomes range from good recovery to death. Long term consequences of a TBI can include:

  • Difficulty concentrating or having a short attention span.

  • Change in personality.

  • Irritability.

  • Headaches.

  • Blurry vision.

  • Sleepiness.

  • Depression.

  • Unsteadiness that makes walking or standing hard to do.

For more information and support, contact: The National Institute of Neurological Disorders and Stroke.