**1. Introduction**

Younger people in developing countries are more frequently affected by head injuries, which have substantial economic and social effects. In patients with traumatic brain injury (TBI), external or internal haemorrhages have the potential to cause systemic hypotension [1, 2]. They can be associated with poorer outcomes (increased morbidity and mortality) compared to patients with TBI alone [3, 4]. Even brief episodes of hypotension have been shown to cause both systemic and cerebral hypoperfusion and secondary brain injury [5]. This systemic hypertension can be further complicated by raised intracranial pressure (due to TBI-related lesions), which can further compound the treatment protocols [6]. In trauma patients, the occurrence of haemorrhagic shock is associated with high mortality (as high as 50%) [7], and the reported incidence ranges from 6-16% [8]. These cases need to be differentiated from those in the paediatric population, where the isolated TBI can lead to severe shock (in the absence of apparent haemorrhage) [9, 10]. Understanding the interaction of the simultaneous presence of TBI and haemorrhagic shock is essential to implement the optimal resuscitation strategy [11] and, thus, developing strategies to improve outcomes in this subgroup of patients [5]. Investigators have used animal models to define the optimal post-resuscitation mean arterial pressure levels to ensure organ perfusion and, thus, maintain good organ functions and survival patterns [2]. The present article discusses the concepts and controversies associated with concurrent TBI and haemorrhagic shock, the clinical approach, and the management of this subgroup of patients.
