This issue brief provides an overview of the "state of the state" for traumatic brain injury (TBI) issues and challenges in North Carolina. A previous issue of the North Carolina Medical Journal discussed this topic approximately 14 years ago, and this issue brief showcases changes and advances since that time. Collectively, articles in the current issue highlight the current epidemiology of TBI; the rapidly advancing and critical topic of concussions; special populations where TBI is seen more frequently, such as elderly individuals and veterans; advances in TBI-related treatments; and the all-important family perspective on TBI. Additionally, this issue brief discusses key developments and advances in the state related to a statewide needs assessment; legislative and policy actions, including a new sports concussion awareness act and a significantly revised definition of TBI as it relates to special education classification; and ongoing exploration of evidence-based community services that have the potential to improve our system of care for adults with TBI. Finally, ongoing challenges are detailed with the intention of pushing the state to become one of the nation's leaders in TBI services.