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Penetrating Brain Injury

(Brain Injury, Penetrating; Penetrating Wound to the Head; Wound to the Head, Penetrating)

Definition

This type of traumatic injury occurs when an object penetrates the skull and damages the brain. One part of the brain may be damaged. Damage can also occur to a larger area of the brain. This is a serious, life-threatening injury. It requires emergency medical care.

The Brain

When a penetrating brain injury occurs, one area of the brain may be damaged or a larger region.

Causes

Penetrating brain injuries may be caused by any object or external force, such as:

Fall (could cause a piece of the skull to break off and penetrate the brain)

Motor vehicle accident

Gunshot wound to the head

Stab wound to the head

Sports-related injury

Abuse (being struck on the head with an object)

Risk Factors

Risk factors include:

Being elderly (higher risk of falls) or younger (higher risk of motor vehicle accidents)

Abusing alcohol or drugs

Being in a violent environment

Playing high-impact sports

Symptoms

A penetrating brain injury is very serious and can lead to death. Gunshot wounds to the head are often fatal. The symptoms, though, vary depending on what caused the injury and how severe it is. Symptoms may include:

Heavy bleeding from the head

Bleeding from the ears

Difficulty breathing

Seizure

Loss of bowel and bladder function

Loss of movement or sensation in the limbs ( paraplegia )

Loss of consciousness (A coma may occur after the injury.)

Diagnosis

Because of the severity of this kind of injury, the doctor will evaluate the person as quickly as possible in the emergency room. This may include:

Checking heart and lung function

Checking the persons level of consciousness

Checking reflexes, strength, and sensation

Examining the entire body for other injuries

Depending on the person’s condition, the following tests may be done:

X-rays and CT scan of the head and spine

Blood tests

MRI scan (This may be done once the condition has been stabilized.)

Treatment

The treatment plan depends on a number of factors, including the:

Severity of the injury

Areas of the brain that were damaged

Symptoms

Initial Treatment

The hospital staff will first attempt to stabilize life. If there is bleeding, steps will be taken to stop the bleeding as quickly as possible. This may include doing emergency surgery. To help the person breathe, a tube may be placed down the throat and into the lungs. Also, fluids and blood will be given to keep the blood pressure stable.

Surgery

Depending on the injury, a neurosurgeon (a doctor that specializes in brain and spinal cord surgery) may need to:

Remove skull fragments that broke off during the injury—A bullet or other object may also need to be removed.

Remove part of the skull (decompressive craniectomy)—The brain often expands and swells after a severe injury. Removing a part of the skull gives the brain room to expand.

Make "burr holes" in the scalp and skull to drain clotting blood ( hematoma )

Place a catheter into the brain to drain cerebrospinal fluid

The doctor may also place monitoring devices in the brain to check the:

Pressure in the brain

Temperature of the brain and the oxygen levels

Medication

Seizures may occur after a traumatic brain injury. Because of this, the doctor may give anti-seizure medicines. Strong pain relieving medicines, like opioids, may be given through a vein in the arm.

Rehabilitation

After the condition has improved, the doctors will create a rehabilitation program that may include working with:

A physical therapist

An occupational therapist

A doctor who specializes in physical medicine and rehabilitation

A neurologist

A psychologist

The goal is to help the person regain as much functioning as possible.

Prevention

Here are ways to prevent this type of trauma to your brain:

Reduce the risk of gun accidents by:

Keeping guns unloaded and in a locked cabinet or safe

Storing ammunition in a separate location that is also locked

Reduce the risk of falls, especially if you are elderly, by:

Using handrails when walking up and down stairs

Using grab bars in the bathroom and placing non-slip mats in the bathroom

Reduce the risk of motor vehicle accidents by:

Not drinking and driving or getting into a vehicle with someone who is under the influence

Obeying speed limits and other driving laws

Using seatbelts and placing children in proper child safety seats

Wearing a helmet when participating in certain sports and when riding on a motorcycle

Avoiding taking medicines that make you sleepy, especially when driving

You can also prevent brain injuries by getting help if you are in a violent environment.

RESOURCES:

American Academy of Neurology

http://www.aan.com/

Brain Injury Association of America

http://www.biausa.org/

CANADIAN RESOURCES:

The Brain Injury Association of Canada

http://biac-aclc.ca/

Ontario Brain Injury Association

http://www.obia.on.ca/

References:

Barth J, Hillary F. Closed and penetrating head injuries. Saint Joseph’s University website. Available at: http://schatz.sju.edu/neuro/patho/pathophysiology.html . Accessed March 31, 2011.

Cranial gunshot wound. New York Presbyterian Hospital website. Available at: http://nyp.org/health/cranial-gunshot-wounds.html . Accessed March 31, 2011.

Cranial gunshot wounds. University of California, Los Angeles Health System website. Available at: http://neurosurgery.ucla.edu/body.cfm?id=134 . Accessed March 31, 2011.

DynaMed Editorial Team. Traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 21, 2011. Accessed March 31, 2011.

Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at: http://www.unc.edu/~rowlett/units/scales/glasgow.htm . Updated March 31, 2011.

Gossett C. Gunshot wounds: a primer. Temple College website. Available at: http://www.templejc.edu/dept/ems/Pdf/CE%20Articles/GUNSHOT.PDF . Accessed March 31, 2011.

Gunshot wound head trauma. American Association of Neurological Surgeons website. Available at: http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Gunshot%20Wound%20Head%20Trauma.aspx . Accessed March 31, 2011.

Neff D. Closed head injury. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated February 16, 2011. Accessed March 31, 2011.

Penetrating injury. Brain and Spinal Cord.org website. Available at: http://www.brainandspinalcord.org/traumatic-brain-injury-types/penetrating-brain-injury/index.html . Accessed March 31, 2011.

Salisbury D, Novack T, Brunner R. TBI inform—traumatic brain injury caused by violence. Traumatic Brain Injury Model System website. Available at: http://main.uab.edu/tbi/show.asp?durki=85704 . Accessed March 31, 2011.

Treating trauma: what you need to know to save a life. Available at: http://webdoc.nyumc.org/nyumc/files/libra/u2/Treating_Trauma_Fall_06.pdf . Published 2006. Accessed March 31, 2011.

Understanding TBI. Virginia Commonwealth University website. Available at: http://www.tbi.pmr.vcu.edu/FactSheets/Understanding_Part1.pdf . Updated February 8, 2010. Accessed March 31, 2011.

What is brain injury? Brain Injury Association of Utah website. Available at: http://www.biau.org/what/what.html . Accessed March 31, 2011.

Last reviewed June 2012 by Igor Puzanov, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.