Opened in 2014, Mission Hospital's Neuroscience & Spine Institute stands as the premier neurosurgical facility in Orange County

Minor, Moderate and Severe Traumatic Brain Injury (TBI)

Another way to sort out a brain injury is by how it effects the functions of the person. The team checks the person and grades their brain function using a scale called the Glasgow Coma Scale (GCS). This scale checks how well the person can talk, move/follow commands, and open their eyes. It is scored from 15 has the highest and best score to 3 which is the lowest score. A minor TBI is scored as a GCS 13-15. A moderate TBI is scored as a GCS 9-12. A severe TBI is scored as a GCS 3-8. Depending on the score and the results of the tests that are done, the team of doctors/nurses/therapists care for the person with brain injury using medications and treatments to help control injury and the aftereffects of the injury.

Minor TBI and Concussion

Sometimes Concussion and Minor TBI are used to describe the same thing but they are different. A minor TBI could mean a simple concussion or the person has a GCS 13-15 and can have a skull fracture or bleeding around the brain.

A concussion is a mild injury to the brain where the normal functions are disrupted. It is a physiologic change in the brain usually involving chemicals (neurotransmittors and sugar in the blood/brain). A concussion produces a functional problem not a structural problem (like broken bones). Almost 90-95% of concussions occur without the person losing consciousness. They are awake, confused or dazed, forgetful, slow to answer questions, and sometimes show strange behavior (body shaking all over, eyes rolled back) or aggressive behavior. The person with a concussion may not remember what happened to them; they often repeat questions and answers over and over again; they complain of headache, nausea, dizziness, double vision, sensitivity to light/noise, confusion, feeling foggy, and/or problems with concentration. These symptoms are usually reversible.

It is important to remember that athletes in school programs or league play can receive a concussion during the event. Mission Hospital has put together a special booklet called “CHAMP and the 5 R’s” to help everyone from coaches, trainers, teachers to parents and athletes on how to deal with a concussion.

Patients with a GCS of 15 may be sent home from the Emergency Department because the brain function is normal and the person is awake with only a headache or mild dizziness. These patients will receive special instructions on care after they go home and making sure they have information on following up with the concussion clinic or their primary care doctors.

Rest is Key

Resting the brain and body are very important. In today’s fast paced, complicated world, rest can be a challenge but is important for the brain’s recovery. After the concussion, avoid activities that are physically demanding or require a lot of thinking. Initially, avoid texting, TV, video games, computer work, school work, reading and doing multiple things at one time (like reading the paper and exercising).

When someone has a concussion, it is very important that the individual sees a doctor after the concussion. There are many symptoms people normally have after brain injury. However, there are some symptoms that are considered red flags.

Red Flags

If you show any of these symptoms after your brain injury, you, or the person watching you, should call your doctor or go to the Emergency Room:

  • Headaches that get worse and do not go away
  • Neck pain or stiff neck
  • Convulsions or seizures (jerking of body or limbs)
  • Become very drowsy or can’t stay awake or passes out
  • Difficulty walking or difficulties with balance
  • Difficulty with vision
  • Getting more confused, restless or agitated
  • Vomiting or throwing up
  • Can’t recognize people/places or remember new events
  • Slurred speech
  • Weakness or numbness of parts of the body
  • Fever
  • Unusual behavior changes (acting strangely) or irritable

The normal symptoms that can happen after a concussion include feeling foggy, headache, dizziness, sensitivity to light/noise, and/or problems thinking. These usually go away after a few days. If the symptoms do not go away and continue, then it is important to see a concussion expert, such as a neurologist or neuropsychologist. When symptoms last for weeks or months, it is called Post-Concussion Syndrome (PCS). Below includes a listing of different symptoms associated with PCS. If you experience symptoms of PCS, it is important to make an appointment with a concussion expert so he/she can help with the recovery.


  • Difficulty thinking clearly
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering new information


  • Headache
  • Fuzzy or blurry vision
  • Nausea or vomiting (early on)
  • Dizziness
  • Sensitivity to noise or light
  • Balance problems
  • Feeling tired, having no energy


  • Irritability
  • Sadness
  • More emotional or emotionally labile
  • Nervousness or anxiety


  • Sleeping more than usual
  • Sleeping less than usual
  • Trouble falling asleep

Patients with skull fractures and a GCS 13-15 usually are kept in the hospital for a time to watch them to make sure there are no other changes following the injury. Once the doctors determine the injury is not changing and the person is stable, the patient will be sent home with directions on following up with the primary care doctors.

Moderate TBI

Patients with a GCS of 9-12 are considered a moderate TBI. These patients must be watched closely to assure they do not get worse and become a severe TBI. It is common for elderly people to have this type of brain injury because brains shrink as people get older and there is more space inside the skull. The patient can have injuries to the brain such as bruises (contusions) and small amounts of blood inside the skull around the coverings of the brain. These are common in moderate TBI. Since it is a smaller of amount of swelling or bleeding, the patient is usually awake but confused and sleepy. The team of doctors, nurses, and therapists watch the moderate TBI patient closely and provide the care they need based on how it affects them.

Severe TBI

Patients with a GCS of 3-8 are in the category of the most severe type of brain injury. Generally these patients are not awake and have swelling of the brain with or without bleeding inside the bones of the skull. If there is a severe brain injury, the patient is cared for in the intensive care unit. There is a team of doctors, nurses and therapists that uses a special protocol to manage the injured brain. A medical protocol is a set of research-based guidelines used for the treatment of an injury or illness.