Traumatic Brain Injury Basics

Michael Paul Mason, Brain Injury Case Manager
TBI Basics


Doctors say that traumatic brain injury (TBI) is a catastrophic condition, like burns, amputations, and spinal cord injuries. But TBI is different. It upsets life on multiple levels: physical, psychological, social, and even spiritual. TBI affects the roots of who we are — our ability to think, to communicate, and to connect with other people. For approximately 85 percent of people with TBI, those problems eventually resolve, but the remaining 15 percent have lasting difficulties. If you’re dealing with lingering symptoms of a TBI, or if you’re caring for a loved one, it can help to understand more about the wide range of challenges that TBI can pose.

A tap on the head, and anything can go wrong. Anything usually does go wrong. Light taps — mild TBI — can result in daily headaches, agitated moods, or periods of sleeplessness. Stronger jolts may cause you to forget your name, or make you think you’re someone different. When you tell someone you’re sad, you may unintentionally yell. A TBI can introduce a frustrating amount of confusion and uncertainty into your life

TBI by the Numbers

TBI has a way of affecting everything and everyone in your life. It can make family life tough, and it can seriously impede your ability to work. It can affect the relationships you have and make it harder to make new friends. In the United States, TBI is a quiet crisis. As many as 5.3 million Americans are living with a permanent disability resulting from a brain injury. The Centers for Disease Control and Prevention report that 2.8 million Americans report a traumatic brain injury each year. Fifty-six thousand people die from it. Over a two hundred eighty-two thousand people are hospitalized. Some of them go home only to discover they no longer have a sense of smell or taste, or that their sleeping habits have changed, or that they can’t seem to do their job anymore. 

If you look at the numbers a little differently, they’re even more upsetting. So many Americans become disabled from a brain injury that each decade they could fill a city the size of Detroit. Seven of these cities are filled already. A third of their citizens are under fourteen years of age. Currently, there are at least 125,000 people with a brain injury so severe that it requires extended hospital care — a service difficult to find and even harder to access. Fortunately, the majority of people who experience TBI will be able to return to a productive life once they receive appropriate treatment

A Closer Look at the Brain

Even though the numbers are large, it’s important to remember that TBI is a human injury. It has a way of showing us that life is fragile and precious. Because the brain is a complicated network of cells, each injury is as distinctive as the person it affects. Our skulls are only a quarter inch thick, although male skulls are a little thicker, which is lucky considering the fact that men tend to get TBI more often than women. The skull is both protective and restricting; it is the brain’s best defense but also its greatest risk in times of trauma.

Surrounding the brain is an almost rubbery, clear layer of tissue called the dura mater. It helps protect the brain from moving around too much. Beneath the dura mater is another layer called the arachnoid layer, which looks and feels like wet cotton candy. The dura mater, the arachnoid layer, and another layer — the pia mater — all form what is known as the meninges, which keeps the brain floating inside the skull. If these layers get infected, ripped, or torn, it can cause serious damage to the brain

Types of TBI

Every brain injury is different, but there are two basic types: open head injuries and closed head injuries. Open head TBIs are a frightening mess. Whether the injury comes from a bullet, a baseball bat, or a high-speed collision, the result is always chaotic and distressing. The scalp bleeds a lot when it is cut, and when the skull is cracked or penetrated, pieces of it can get lodged in the brain. Because the brain is such a complicated tangle of tissue, it’s extremely tricky to remove objects lodged inside a brain. That’s why we put brain surgery right up there with rocket science in our everyday language.

In a closed head injury, nothing penetrates your skull, but a closed head injury can be just as complicated and vicious as an open head injury, sometimes more so. During a closed head injury, the brain may slam against one portion of the skull, then bounce against the opposite side of the wall. Doctors call that a “coup-contracoup” injury, where two injuries occur from a single blow. One of the most common types of closed head injury is a concussion — a strong blow from an external force. If a person’s head is whipped around, a small tearing effect called shearing occurs throughout the brain, resulting in a diffuse axonal injury. Axons are the hairlike extensions of nerve cells that transmit messages, so in a diffuse axonal injury, the messages either get mixed up, or they don’t come through at all

Treating and Living With TBI

An injured brain also has a tendency to swell, so if there is no room in the skull to expand, the swollen brain may start pushing against the eye sockets. The optic nerve eventually gets pinched, and eyesight is affected. A surgeon might drill holes into a skull to test cranial pressure. If the swelling is too extreme, the only option is to create an escape hatch by sawing away a portion of the skull.

The neurosurgeon is in charge of protecting the brain through medical procedures, but the survivor has to manage life with the effects of the TBI. Everyone reacts differently, depending in part on the severity of the injury, the quality of their care, and the strength of the social network around them. Many survivors feel pulled in different directions, feeling at times that the injury has made them less than what they were, and at other times that they can integrate TBI into their lives in a positive way. People with TBI are forced to confront a whole series of personal questions: How does my injury really affect me? Can I regain the things I’ve lost? What am I other than my brain? How can I make the most of my life?

Looking Ahead

Our understanding of TBI is changing in front of our eyes. As organizations such as the Brain Trauma Foundation continue to define the best practices in treating brain injury, medical care is slowly improving — at least for those patients able to gain access to early trauma care. The war in Iraq has already changed the way we treat TBI in America. Military surgeons who learned life-saving techniques like early cranioplasty are able to employ similar protocols in American trauma centers 

In the years to come, we may increasingly see brain trauma as a chronic but manageable condition similar to diabetes or cardio-pulmonary disease. That perspective might also help in reducing the negative stereotypes of TBI. For now, though, TBI survivors and those who care for them continue to face serious challenges in finding help and finding acceptance.

TBI is a much more manageable injury today than it has been in the past, but it remains a major health problem. As people with TBI continue to live longer and face the challenges of aging with TBI, it will be our duty to provide better education and long-term programs and services. We all have brains; let’s continue to use them — injured or not — to support TBI prevention, research, and treatment.

Posted on BrainLine February 13, 2018. Reviewed March 27, 2019.

About the Author

Michael Paul Mason is the founding editor of This Land, a monthly magazine based in Tulsa. Mason's first book, Head Cases: Stories of Brain Injury and Its Aftermath, is an exploration into the harsh realities endured by people with brain injury. Mason's first book, Head Cases: Stories of Brain Injury and Its Aftermath, is an exploration into the harsh realities endured by brain injury survivors. While currently a brain injury projects manager at the Neurologic Rehabilitation Institute at Brookhaven Hospital, Mason continues to advocate on behalf of Americans with brain injury and is involved with several national legislative initiatives. Learn more about Michael Paul Mason >

Comments (325)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

My 85 year old husband fell down our steps. He was on blood thinners and his entire brain was covered in blood. The hospital told me that he would not survive. This happened on 11/24/2012 he has been in six acute centers and is slowly getting better. He is scheduled to go to a sub-acute but he is in a stage where he is confused and gets very angry. He has slapped PT and nurses. Before he was gentle and had never laid a hand on a woman.will this stop as his brain heals more or is there any way to deal with it. The neurologist said that his brain should be healed in 6 months and she expects a total recovery. I just don\'t know how to help him now.
I was 3 when my birth mother threw me into a protruded corner of her apartment, which split my head open above my eyebrow, I am now 32 and have fire running down the left side of my face, my scar (which is a hole in my head covered with skin) is always sore, and I wake wth blood on my pillow and often when coming out of the shower I seee blood running out of my nose. I have intense pressure in my left had side of my skull the side the injury almost 3 decades ago happened. No doctor can explain or takes the time to help me with this. Would a neurologist me able to tell me whether there is further injuries happening because of the growth from the injury happening? I am so unsure of what or where to go for help. I have had an MRI to see if there were any tumors, but no. I am slowly forgetting things too, I am extremely educated, and have a demanding job, but my concentration is everywhere else.
I am new to this, my husband suffered a serious TBI during a motorcycle accident this last summer, while the doctors said we shouldn't be concerned with long-term brain injury, I suspect they were more concerned with motor-skills and not the personality changes which cannot be seen on a CT scan or x-ray. Why do doctors not discuss this? Why do I feel like I am doing my own research where there are so many with this issue? Thanks for listening, even for just a moment.
Neurofeedback can have a substantial impact for those with TBI. Check out EEGinfo.
I was hit by a car in 1961 and was told by my doctor that I wasn't going to remember my parents at the time. Then during my school years I had such a difficult time with school work that I would try so hard to memorize every word just so I would pass my test. Even now it's very hard to get out into words what I want to say. I have always used my looks to get where I needed to be . Now I'm realizing that maybe this is all due to my head injury . I have a difficult time staying focus. Can't remember what I have read most of time, can't carry conversations with groups of people, never received my high school diploma . I tried to take a GED test and failed. I did see a neurologist and was tested, did have low test scores. There was no follow ups due to no coverage. That was six years ago. I have been reading up on TBI , wow! I never really gave this a thought. I always thought maybe I did have a learning disability...and yes it can happen. My thinking is very different that's for sure. Now that I'm getting older I'm noticing cognitive problems, memory, can't get words out right, It's hard now a days to get help. So now I'm thinging on applying for disability and that I have to prove to them That I have TBI . That maybe difficult.
I am going through a TBI now with my fiancee. On October 12, 2012 he fell down 16 steps at our home and has had 2 surgeries the first 12 hours for bleeding on the brain. I am researching anything I can find on this horrific accident. He has only squeezed my hand a couple of times and the nurse once on command. He can move his left side, when he wants to, does move his right arm, leg and toes. He yawns, stretches and has been removed from the vent only has a teach. I have not left him and do not plan on doing so and I keep talking to him. Can anyone give me a time frame on this? I am not sorry, I miss him.
My wife and I was shopping at Costco's when 4 washing machines fell 2 of which fell from around 30 feet from the highest wrecking, where 8 washing machines was stacked and overhanging. She was hit by the falling machines and thrown 10 feet away out of my arms with blood coming out of her mouth, I thought that was the end of my life, I ran to comfort her but she had no reactions for a short time and finally open her eyes but could not say nothing. She fractured 3 vertebrae’s and bruises to her head and chest. I believe that she has TBI but the defendant’s expert witnesses say that she has dementia rather than the cause of the accident. The NHS failed to recognise that my wife had received a brain injury even though she had bruises to her head. My wife was not offered any rehabilitation in 2003 at the time of the accident, she was offered rehab in 2006, by then I did not trust the NHS any longer to put my wife in their hands. Till today my wife still has not received her compensation for her injuries and the cost of surviving in society. It is disgraceful that consultants and expert witnesses work in the interests of insurance companies, and may I add corrupt legal and judicial system protects the huge corporations that run our society. Pleading to our MP Andy Love to resolve our problems releasing my wives compensation to survive.
Was just doing research on concussions and found this. My daughter was an athlete and had numerous concussions during her college career. After one last hit her senior, she was sent to a specialist and he stopped her from playing. She had already suffered considerable damage. It is 12 years later and she has constant problems - headaches, not thinking clearly, etc. She recently had mutiple stresses in her life and went into deep depression. She is now in therapy for the depression and in rehab for the TBI's she received. She has been successful but her job now is at risk as she has not been able to return 100% to her job. I am frightened as to what her future holds - does it ever get better or is this going to be something that will continually get worse. She is in her early 30's and has so much life to lead.
In 1979 I was shot through the frontal part of my head by a 22 pistol. I was in the hospital for a while. Now at 42 I am dealing with issues along with nerves not being numb anymore. I try my best at dealing with them but could use some help.
My son who is now 21 had an accident on a quad this past october and was left with t.b.i., broken back and neck, unable to speak or walk. I don't know where to go for guidance or help. If anyone can guide me or send me info on anything please contact me at God Bless!
when I was a young teenager,i remember not feeling well,next thing I knew,I could not recognize objects around,I found it extremely stressful not being able to put a name to objects and what there purpose was,within a few hours, my condition returned to normal,to this day I don't know what caused it,virus?
I fell down the steps of my mother\'s basement when going after her cat. I fell on my right side and bruised the left side of my brain from the impact. I stayed in the hospital for 50 days and am now home learning how to live again. I have long and short term memory loss. I recognize people I have known all my life but I have to ask their name. My family has to repeat everything over and over. Some of it sticks with me but most of it does not. Even though I recognize objects and people, I cannot always call them by name which is frustrating. I get my words mixed up. I am in pain with daily headaches, dizziness, gait and confusion. I know who I used to be and feel like I am trapped inside of someone else\'s body as my head feels like it is sitting next to me instead of sitting on my neck. I am thankful to God and feel I have some sort of purpose but cannot imagine what it could be at this moment in my life as I do not feel like doing anything. My wife is typing this for me as there is no way I could begin to pick out the correct keys to type this. I hope one day I will be able to come back to this page with a better story but at this time, I am going through alot. Good luck to all suffering with this. Thanks to my family as I feel like I have a great support system which is the reason I am doing so well.
i had a tbi from an accident in 08. this past july i had surgery for a tumor in my right parietal lobe. i have had extensive theerapy these 3 years, and want to know if this tumor is relevant to the tbi. it was not discovered until 3/08 and the craniotomy showed a bloody mass when removed???? no cancer in the pathology, thank god.
I had a TBI in 1997 after being hit by a car. Thank god I am not paralyzed. five brain cells died.I lost about forty percent use of my right side because the injury was on the left side of the brain. I cannot recognize a quarter if it was put into my hand if i did not look at it. I get dizzy when standing at times. I still drive a car with no problem, but I had to give up my job as a bread delivery driver. I still can lift my younger grand children up. I visit a neurologist every four months. I read about new ways to get brain cells back, but they are not realistic. Life still goes on and I enjoy it, especially when I see how close I came to being fully impaired.
thank you for helping me i was learning about it and this helped alot thank you
My husband went into sudden cardiac arrest one night. I did CPR for 20 minutes before EMS showed up. He later had a heart attack while being wheeled into the emergency room....He has no reccolection of the two weeks prior to heart attack or about two weeks after. This was 2 years ago. His personality changed so drastically. He became engulfed in TV and spent money wildly. He poured himself into religion and began to holler at me all the time. He was very forgetful. This was NOT the man I knew. A therapist I know casually mentioned TBI to me ands said his symptoms were typical but nowhere can I find information on how to convince him that something is not right....
For my TBI and my young nephew's TBI the best thing I did to correct the symptoms was Brain State Technology. It helped on all levels of problems (such as PTSD and memory and speech and writing) I had for 6 yrs. My nephew has it from a fall for 11 years and is now recovering. Also Atlas Evolution was another technique for migraines and headaches for both of session and they were gone after years of suffering. Also The Results System for transposed brain symptoms with Rick Seivertson over the phone. There is help beyond doctors that works and is not so expensive and fast. I even got rid of a seizure disorder I had for 42 years and dropped meds I took all that time doing Brain State Tech. Please don't give up as there are answers out there and you just have to ask life to direct you as I did. Often I felt like it would never end. Then I would find the right treatment and feel like the miracle wonder that I healed so fast and easily. Hope this helps in your journey to recovery. I wish you all the best.
I have a history of remote head injuries and in 2008 after i fall, it was discover, that I had a tumor in the front of my brain.During my ordeal my Service was allow3ed to stay with me.Please, check out my story. My dog, Henry Miller died with me at his sided on march 26,2010; He died eleven months after my operation that took place on 4/3/2009. There is another story which is called "Inner Circle". For this story, please go to I hope whoever read fhese, I say enjoy. Now I have adopted another dog who will under go training to become a true Service dog. Manish Aghi is a 14 month puppy who was named after my doctor. Manish Aghi. Thank You. Anaperla. " The Healing Power of Pets" found at
I have had multiple catistrophic dirt bike crashes and at the time I was to proud and macho to take the time to go to the er. One of the crashes was so bad I broke my helmet. I am married now and I suffer from NON-stop headaches, Chronic insomnia and as tough as i think I am, I feel the wrecks are taking a toll on me mentally. I no longer enjoy things i used to love. I am consumed by pain and frustration because I have been to over a dozen doctors. Most are idiots and just think I\'m depressed so they push anti-depressants on me. I gave them a try, and I do mean all, but the side affects of those meds tend to aggrivate the problems I\'m trying to fix. If you are a young man and are reading this don\'t always feel like you have to rise to the challenge. I loved the rush I got when I climbed a monster hill or mad a huge jump, but because i chased that rush i now am suffering the consquences. My married life, my work and simply my state of mind are all a mess due to the battle I fight daily. If someone calls you a wuss or a chicken for not wanting to try something dangerous that is not up to your skill level, WALK away! If i could go back and change anything in my life it would be those collisons with mother earth that I so vividly remember even though they were over 6 years ago. All I do is pray for Gos to relieve me of the misery I am in. I believe he will heal me of my alligments in his time. Lord knows these doctors don\'t have a clue about how to help. Just remember this, whatever mountain or hill challenges you, that challenge will still be there if your instincts tell you your not ready. I made the mistake of ignorning those God given instincts. With age and counsel from God comes wisdom!!
I found this information to be very interesting. I've had two brain hemorrhages.
Thank you! I am in high school in biology 30 and I am trying to learn more and study about the brain and what can happen and this really helped!! I LOVE these kinds of websites! :)
thank u 4 the tbi info it was very helpful. my cuzn had a tbi. he is much better thank GOD for JESUS' wounds. praise the LORD...
its useful for my project work as am a audiologist
Thanks, even us stroke people can learn from your info. Gary Schaaf Huber Heights, Ohio 45424