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.
When a penetrating brain injury occurs, damage to the brain may occur in one area or a larger region.
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Penetrating brain injuries may be caused by any object or external force, such as: Fall, which could cause a piece of the skull to break off and penetrate the brainMotor vehicle accidentGunshot wound to the headStab wound to the headSports-related injuryAbuse, such as being struck on the head with an object
Factors that increase your chance of a penetrating brain injury include: Being elderly (higher risk of falls) or younger (higher risk of motor vehicle accidents)Alcohol use disorder
drug abuseBeing in a violent environmentPlaying high-impact sports
A penetrating brain injury is very serious and can lead to death. Gunshot wounds to the head are often fatal. Symptoms vary depending on what caused the injury and how severe it is. They may include: Heavy bleeding from the headBleeding from the earsDifficulty breathingSeizureLoss of bowel and bladder function
Loss of movement or sensation in the limbs—
Loss of consciousnessComa
may occur after the injury
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 functionChecking the persons level of consciousnessChecking reflexes, strength, and sensationExamining the entire body for other injuries
Depending on the person’s condition, the following tests may be done: X-rays
of the head and spine
Blood testsMRI scan
—this may be done once the condition has been stabilized
The treatment plan depends on a number of factors, including the: Severity of the injuryAreas of the brain that were damagedSymptoms
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 emergency surgery. To help with breathing, 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.
Depending on the injury, a neurosurgeon 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 from a
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 brainTemperature of the brain and the oxygen levels
Seizures may occur after a traumatic brain injury. Because of this, the doctor may give anti-seizure medications. Strong pain relievers, like opioids, may be given through an IV.
After the condition has improved, the doctors will create a rehabilitation program that may include working with: A physical therapistAn occupational therapistA doctor who specializes in physical medicine and rehabilitationA neurologistA psychologist
The goal is to help the person regain as much functioning as possible.
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 safeStoring 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 stairsUsing 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 of drugs or alcoholObeying speed limits and other driving lawsUsing seatbelts and placing children in proper child safety seatsWearing a helmet when participating in certain sports and when riding on a motorcycleAvoiding taking medications that make you sleepy, especially when driving
You can also prevent brain injuries by getting help if you are in a violent environment.
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 May 13, 2016.
Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated March 31, 2016. Accessed May 13, 2016.
Cranial gunshot wounds. UCLA Health website. Available at:
http://neurosurgery.ucla.edu/cranial-gunshot-wounds. Accessed May 13, 2016.
Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at:
http://www.unc.edu/~rowlett/units/scales/glasgow.htm. Accessed May 13, 2016.
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 May 13, 2016.
Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated April 21, 2016. Accessed May 13, 2016.
Traumatic brain injury & concussion. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/traumaticbraininjury. Updated February 9, 2016. Accessed May 13, 2016.
Last reviewed May 2016 by Rimas Lukas, 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.
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