Traumatic Brain Injury


Traumatic brain injury, generally defined as an alteration in brain function, or other evidence of brain pathology as a result of an external force, has established itself as a significant threat to public health. It impacts survivors and their families, and demonstrates clear economic repercussions at the societal level, costing hundreds of billions of dollars annually worldwide. To detect, manage and prevent this complex and often lifelong disabling injury, it is essential to understand its distribution and patterns, and have comprehensive knowledge of persons at risk of injury and adverse outcomes.

Key Concepts

  • Traumatic brain injury (TBI) is on the rise worldwide.
  • The lack of a universal definition of TBI presents a problem for quantification of true TBI burden.
  • The baseline clinical severity measures for TBI are often based on symptomatology, loss of consciousness and post‐traumatic amnesia; discordance between clinical severity and evidence of injury based on neuroimaging is common; investment in biomarkers of neuronal and glial integrity is growing.
  • Persons with similar injury severity and acute presentation can experience significantly different clinical course and functional outcomes.
  • Certain groups of people are more vulnerable to TBI and adverse outcomes than others, owing to unique interactions between their biological, behavioural, social and cultural standing before and after the injury.
  • Clinicians, researchers and policy leaders dealing with critical injuries with long‐lasting effects such as TBI cannot afford to leave its probability in the future to chance; greater investment in injury prevention is timely.

Keywords: brain injury; concussion; biomechanics; diagnosis; prognosis; motor and cognitive problems; behavioural impairments; rehabilitation; injury prevention

Figure 1. (a) Image depicting the mechanism of a concussion – a direct blow or sudden deceleration or acceleration forces brought on the head or upper body causing the brain to move within the skull; (b) types of damage to neurons occurring in TBI, and characterising diffuse axonal injury; (c) hematomas – a consequence of TBI where blood pools within the skull due to shearing forces vectored at blood vessels. Adapted from, and
Figure 2. Impact of TBI – incidence rates across populations. Graph created using pooled incidence values reported in systematic review and meta‐analysis by Nguyen et al., . Error bars represent 95% confidence intervals.


Andriessen TM, Jacobs B and Vos PE (2010) Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. Journal of Cellular and Molecular Medicine 14 (10): 2381–2392.

Annegers JF, Grabow JD, Kurland LT and Laws ER Jr (1980) The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935‐1974. Neurology 30 (9): 912–919.

Best MD, Suminski AJ, Takahashi K, Brown KA and Hatsopoulos NG (2017) Spatio‐temporal patterning in primary motor cortex at movement onset. Cerebral Cortex 27 (2): 1491–1500.

Binder JR (2017) Current controversies on Wernicke's area and its role in language. Current Neurology and Neuroscience Reports 17 (8): 58.

Black KL, Hanks RA, Wood DL, et al. (2002) Blunt versus penetrating violent traumatic brain injury: frequency and factors associated with secondary conditions and complications. Journal of Head Trauma Rehabilitation 17 (6): 489–496.

Brain Injury Association of America (2019) About Brain Injury. (accessed 2 September 2019).

Brain Trauma Foundation (2013) Traumatic Brain Injury Statistics. Brain Trauma Foundation. (accessed 2 September 2019).

Brown JB, Kheng M, Carney NA, Rubiano AM and Puyana JC (2019a) Geographical disparity and traumatic brain injury in America: rural areas suffer poorer outcomes. Journal of Neurosciences in Rural Practice 10 (1): 10–15.

Brown MJN, Weissbach A, Pauly MG, et al. (2019b) Somatosensory‐motor cortex interactions measured using dual‐site transcranial magnetic stimulation. Brain Stimulation 12 (5): 1229–1243. DOI: 10.1016/j.brs.2019.04.009.

Carron SF, Alwis DS and Rajan R (2016) Traumatic brain injury and neuronal functionality changes in sensory cortex. Frontiers in Systems Neuroscience 10: 47.

Churchill NW, Caverzasi E, Graham SJ, Hutchison MG and Schweizer TA (2017) White matter microstructure in athletes with a history of concussion: comparing diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI). Human Brain Mapping 38 (8): 4201–4211.

Clayton E, Kinley‐Cooper SK, Weber RA and Adkins DL (2016) Brain stimulation: neuromodulation as a potential treatment for motor recovery following traumatic brain injury. Brain Research 1640 (Pt A): 130–138.

Damiano DL, Zampieri C, Ge J, Acevedo A and Dsurney J (2016) Effects of a rapid‐resisted elliptical training program on motor, cognitive and neurobehavioral functioning in adults with chronic traumatic brain injury. Experimental Brain Research 234 (8): 2245–2252.

Fischer DB, Boes AD, Demertzi A, et al. (2016) A human brain network derived from coma‐causing brainstem lesions. Neurology 87 (23): 2427–2434. DOI: 10.1212/WNL.0000000000003404.

Fishbein D, Dariotis JK, Ferguson PL and Pickelsimer EE (2016) Relationships between traumatic brain injury and illicit drug use and their association with aggression in inmates. International Journal of Offender Therapy and Comparative Criminology 60 (5): 575–597.

Flinker A, Korzeniewska A, Shestyuk AY, et al. (2015) Redefining the role of Broca's area in speech. Proceedings of the National Academy of Sciences of the United States of America 112 (9): 2871–2875.

Fu TS, Jing R, McFaull SR and Cusimano MD (2015) Recent trends in hospitalization and in‐hospital mortality associated with traumatic brain injury in Canada: a nationwide, population‐based study. The Journal of Trauma and Acute Care Surgery 79 (3): 449–454.

GBD 2016 Neurology Collaborators (2019) Global, regional, and national burden of neurological disorders, 1990‐2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology 18 (5): 459–480.

Hwang SW, Colantonio A, Chiu S, et al. (2008) The effect of traumatic brain injury on the health of homeless people. Canadian Medical Association Journal 179 (8): 779–784.

Jang SH (2014) The corticospinal tract from the viewpoint of brain rehabilitation. Journal of Rehabilitation Medicine 46 (3): 193–199.

Kerr ZY, Harmon KJ, Marshall SW, Proescholdbell SK and Waller AE (2014) The epidemiology of traumatic brain injuries treated in emergency departments in North Carolina, 2010–2011. North Carolina Medical Journal 75 (1): 8–14.

Kriegel J, Papadopoulos Z and McKee AC (2018) Chronic traumatic encephalopathy: is latency in symptom onset explained by Tau propagation? Cold Spring Harbor Perspectives in Medicine 8 (2): pii, a024059.

Krug EG, Dahlberg LL, Mercy JA, Zwi AB and Lozano R (2002) World Report on Violence and Health. World Health Organization: Geneva.

Lasry O, Liu EY, Powell GA, et al. (2017) Epidemiology of recurrent traumatic brain injury in the general population: a systematic review. Neurology 89 (21): 2198–2209.

Liu NK, Zhang YP, Zou J, et al. (2014) A semicircular controlled cortical impact produces long‐term motor and cognitive dysfunction that correlates well with damage to both the sensorimotor cortex and hippocampus. Brain Research 1576: 18–26.

Ma J, Zhang K, Wang Z and Chen G (2016) Progress of research on diffuse axonal injury after traumatic brain injury. Neural Plasticity 2016: 9746313.

Maroon JC, Winkelman R, Bost J, et al. (2015) Chronic traumatic encephalopathy in contact sports: a systematic review of all reported pathological cases. PLoS One 10 (2): e0117338.

McCrory P, Feddermann‐Demont N, Dvořák J, et al. (2017) What is the definition of sports‐related concussion: a systematic review. British Journal of Sports Medicine 51 (11): 877–887.

McGuire C, Kristman VL, Martin L and Bédard M (2017) Characteristics and incidence of traumatic brain injury in older adults using home care in Ontario from 2003–2013. Canadian Geriatrics Journal 20: 2–9.

Mokri B (2001) The Monro–Kellie hypothesis: applications in CSF volume depletion. Neurology 56 (12): 1746–1748.

Mollayeva T, Mollayeva S and Colantonio A (2018) Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nature Reviews Neurology 14 (12): 711–722.

Mollayeva T, Sutton M, Chan V, et al. (2019a) Data mining to understand health status preceding traumatic brain injury. Scientific Reports 9 (1): 5574.

Mollayeva T, Hurst M, Escobar M and Colantonio A (2019b) Sex‐specific incident dementia in patients with central nervous system trauma. Alzheimers Dement (Amst) 11: 355–367.

Moreno‐López L, Manktelow AE, Sahakian BJ, Menon DK and Stamatakis EA (2017) Anything goes? Regulation of the neural processes underlying response inhibition in TBI patients. European Neuropsychopharmacology 27 (2): 159–169.

van der Naalt J, van Zomeren AH, Sluiter WJ and Minderhoud JM (2000) Acute behavioural disturbances related to imaging studies and outcome in mild‐to‐moderate head injury. Brain Injury 14 (9): 781–788.

Newsome MR, Mayer AR, Lin X, et al. (2016) Chronic effects of blast‐related TBI on subcortical functional connectivity in veterans. Journal of the International Neuropsychological Society 22 (6): 631–642.

Nguyen R, Fiest KM, McChesney J, et al. (2016) The international incidence of traumatic brain injury: a systematic review and meta‐analysis. Can J Neurol Sci. 43 (6): 774–785. DOI: 10.1017/cjn.2016.290.

O'Neil ME, Carlson K, Storzbach D, et al. (2013) Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review [Internet]. Department of Veterans Affairs (US): Washington (DC).

Ozga JE, Povroznik JM, Engler‐Chiurazzi EB and Vonder Haar C (2018) Executive (dys)function after traumatic brain injury: special considerations for behavioral pharmacology. Behavioural Pharmacology 29 (7): 617–667.

Paterno R, Folweiler KA and Cohen AS (2017) Pathophysiology and treatment of memory dysfunction after traumatic brain injury. Current Neurology and Neuroscience Reports 17 (7): 52.

Quaglio G, Gallucci M, Brand H, Dawood A and Cobello F (2017) Traumatic brain injury: a priority for public health policy. The Lancet Neurology 16: 951–952.

Rabinowitz AR and Levin HS (2014) Cognitive sequelae of traumatic brain injury. Psychiatric Clinics of North America 37 (1): 1–11.

Reid MW and Velez CS (2015) Discriminating military and civilian traumatic brain injuries. Molecular and Cellular Neuroscience 66 (Pt B): 123–128.

Sadeh N, Spielberg JM, Logue MW, et al. (2019) Linking genes, circuits, and behavior: network connectivity as a novel endophenotype of externalizing. Psychological Medicine 49 (11): 1905–1913.

Shenton ME, Price BH, Levin L and Edersheim JG (2018) Mild traumatic brain injury: is DTI ready for the courtroom? International Journal of Law and Psychiatry 61: 50–63.

Su E and Bell M (2016) Diffuse axonal injury. In: Laskowitz D and Grant G (eds) Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group. Chapter 3: Boca Raton (FL).

Tamé L, Braun C, Holmes NP, Farné A and Pavani F (2016) Bilateral representations of touch in the primary somatosensory cortex. Cogn Neuropsychol. 33 (1–2): 48–66. DOI: 10.1080/02643294.2016.1159547.

Taylor CA, Bell JM, Breiding MJ and Xu L (2017) Traumatic brain injury‐related emergency department visits, hospitalizations, and deaths ‐ United States, 2007 and 2013. MMWR Surveillance Summaries 66 (9): 1–16.

Topolovec‐Vranic J, Ennis N, Colantonio A, et al. (2012) Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health 12: 1059.

Wasserman EB, Kerr ZY, Zuckerman SL and Covassin T (2016) Epidemiology of sports‐related concussions in National Collegiate Athletic Association Athletes from 2009–2010 to 2013–2014: symptom prevalence, symptom resolution time, and return‐to‐play time. American Journal of Sports Medicine 44 (1): 226–233.

Xiong C, Hanafy S, Chan V, et al. (2019) Comorbidity in adults with traumatic brain injury and all‐cause mortality: a systematic review. BMJ Open. DOI: bmjopen‐2019‐029072. 9(11): e029072.

Zaaimi B, Dean LR and Baker SN (2018) Different contributions of primary motor cortex, reticular formation, and spinal cord to fractionated muscle activation. Journal of Neurophysiology 119 (1): 235–250.

Zaninotto AL, El‐Hagrassy MM, Green JR, et al. (2019) Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: a systematic review. Dementia e Neuropsychologia 13 (2): 172–179.

Zhang J, Puvenna V and Janigro D (2016) Biomarkers of traumatic brain injury and their relationship to pathology. In: Laskowitz D and Grant G (eds) Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group. Chapter 12. Frontiers in Neuroscience: Boca Raton (FL).

Zyck S, Toshkezi G, Krishnamurthy S, et al. (2016) Treatment of penetrating nonmissile traumatic brain injury. Case series and review of the literature. World Neurosurgery 91: 297–307.

Further Reading

Mollayeva T and Colantonio A (2017) Gender, sex and traumatic brain injury: transformative science to optimize patient outcomes. Healthcare Quarterly 20 (1): 6–9. DOI: 10.12927/hcq.2017.25144

Mollayeva T, Mollayeva S, Pacheco N, D'Souza A and Colantonio A (2019) The course and prognostic factors of cognitive outcomes after traumatic brain injury: a systematic review and meta‐analysis. Neuroscience and Biobehavioral Reviews 99: 198–250. DOI: 10.1016/j.neubiorev.2019.01.011.

Sutton M, Chan V, Escobar M, et al. (2019) Neck injury comorbidity in concussion‐related emergency department visits: a population‐based study of sex differences across the life span. Journal of Women's Health (Larchmt). 28 (4): 473–482.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Mollayeva, Tatyana(Jan 2020) Traumatic Brain Injury. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0027190]