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Penetrating Brain Injury

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


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

Brain nerve pathways
When a penetrating brain injury occurs, damage to the brain may occur in one area or a larger region.
Copyright © Nucleus Medical Media, Inc.

Causes    TOP

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 brain
  • Motor vehicle accident
  • Gunshot wound to the head
  • Stab wound to the head
  • Sports-related injury
  • Abuse, such as being struck on the head with an object

Risk Factors    TOP

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 or drug abuse
  • Being in a violent environment
  • Playing high-impact sports

Symptoms    TOP

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 head
  • Bleeding from the ears
  • Difficulty breathing
  • Seizure
  • Loss of bowel and bladder function
  • Loss of movement or sensation in the limbs— paralysis
  • Loss of consciousness
  • Coma may occur after the injury

Diagnosis    TOP

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    TOP

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 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 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    TOP

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.

Rehabilitation    TOP

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    TOP

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 of drugs or alcohol
    • 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 medications that make you sleepy, especially when driving

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


American Academy of Neurology
Brain Injury Association of America


Brain Injury Canada
Ontario Brain Injury Association


Barth J, Hillary F. Closed and penetrating head injuries. Saint Joseph’s University website. Available at:
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Accessed May 13, 2016.
Concussion and mild traumatic brain injury. EBSCO DynaMedPlus website. Available at: http://www.dynamed.... Updated March 31, 2016. Accessed May 13, 2016.
Cranial gunshot wounds. UCLA Health website. Available at:
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Accessed May 13, 2016.
Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at:
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Accessed May 13, 2016.
Gunshot wound head trauma. American Association of Neurological Surgeons website. Available at:
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Accessed May 13, 2016.
Moderate to severe traumatic brain injury. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated May 16, 2016. Accessed September 30, 2016.
Traumatic brain injury & concussion. Centers for Disease Control and Prevention website. Available at:
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Updated February 9, 2016. Accessed May 13, 2016.
Last reviewed May 2016 by Rimas Lukas, MD
Last Updated: 5/30/2014

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