In 1987 80 patients living in the region of St Gallen, Switzerland, suffered from head injury with neuroradiologically visible intracranial lesions (annual incidence 20/100,000). One-quarter died during the first month after injury, and six others during the following 3 years. All except three of the 45 survivors interviewed and examined after 3 years had symptoms and functional impairment related to injury: neuropsychological (78%), behavioural (58%), neurological (53%), and related to bone or soft tissue trauma (36%). Half of the patients suffered from headache. Although these impairments caused little disability--only 5% of the patients had a Glasgow Outcome Score of 2 or 3--handicap in social life was reported in half of them and only 13 of 29 working before the accident were able to resume their former work. The consequences for long-term management of these patients are discussed.