This report consists of 201 patients seen at the Medical College of Virginia from May 1976 to October 1991. They are divided into two groups. The first group is from May 1976 to June 1984 and the second group is from July 1984 to October 1991. The two groups are compared as regards age, Glasgow coma score (GCS), presence of surgical mass lesion, mechanism of injury, intracranial pressure (ICP) course, and outcome. There was a significant difference in the initial GCS between the first and second group with the second group having a lower GCS. In addition, an analysis of the ICP course in group II showed a much lower incidence (5%) of a normal ICP course. There was no difference in outcome between the two groups. The results in the 201 patients are compared to other series.