Traumatic brain injury and the fall of the Aztec empire: 500 years of head injury diagnosis

BACKGROUND: The Aztec civilization has been one of the most powerful and organized cultures in the pre-Columbian era in America. Its fall was due to many factors, including the incursion of Spanish colonization and its violent transculturation, associated with the strong influence of its theological traditions and beliefs, which generated a new configuration in its social structure. METHODS: Through a qualitative analysis and a systematic review based on the keywords Montezuma and TBI (Traumatic Brain Injury), we found 70 texts of interest, of which 32 were selected for their anthropological and medical content and their relationship with the history of neurosurgery. RESULTS: The traumatic brain injury (TBI) controversy and its consequences on this leader’s decision-making capacity and personal and social repercussions is evident. There are basically two versions of the story. That of the TBI was caused by his own people, and the other is the death due to injuries caused by the Spaniards. Historical texts that confirm these findings are presented. CONCLUSION: There is documentary evidence of TBI in the Aztec emperor, which partly explains his decision making behavior in the face of the invading Europeans. However, there is no forensic evidence to determine the causes of his death,