&NA;The Beirut terrorist bombing on October 23, 1983, caused 234 immediate deaths and injured at least 112 survivors. Military medical records were available for each casualty; postmortem examination reports were available for each immediate fatality. This represented a unique opportunity to assess type, incidence, treatment, and outcome of neurological injuries suffered in a mass casualty terrorist bombing situation. Three categories of neurological injuries are described: head injuries, spine and spinal cord injuries, and peripheral nerve injuries. The following types and numbers of injuries occurred among the 112 immediate survivors of the explosion: 37 head injuries—28 concussions, 20 scalp lacerations, 13 skull fractures, 6 facial bone fractures, 4 cerebral contusions, 5 dural lacerations, 2 cerebrospinal fluid fistulas, and 2 intracerebral hematomas; 2 spine or spinal cord injuries—1 cervical and 1 thoracolumbar spine fracture associated with neurological deficit; and 9 peripheral nerve injuries—1 facial nerve palsy, 2 brachial plexus palsies, 1 median and 1 radial nerve palsy, and 4 peroneal nerve palsies. Among 234 immediate fatalities, the types and numbers of neurological injuries were: 167 head injuries—93 scalp lacerations, 85 skull fractures, and 24 facial bone fractures; and 22 spine and spinal cord injuries—15 cervical and 7 thoracolumbar fractures. Seven of the 112 immediate survivors died; 4 of these deaths were related to severe head injuries. The treatment and outcome of survivors with neurological injuries is briefly described. One‐third of the immediate survivors who suffered either a scalp laceration or a concussion had a concomitant skull fracture. Causes for the high initial fatality rate among casualties (70%) and the low mortality rate among immediate survivors (6.3%) relative to literature reports of other terrorists bombings and mass casualty incidents are postulated. (Neurosurgery18:107‐110, 1986)