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

Risk Factors

Factors that increase your chance of a penetrating brain injury include:


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:


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


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

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


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 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.


Here are ways to prevent this type of trauma to your brain:
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: Accessed May 13, 2016.

Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: Updated March 31, 2016. Accessed May 13, 2016.

Cranial gunshot wounds. UCLA Health website. Available at: Accessed May 13, 2016.

Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at: Accessed May 13, 2016.

Gunshot wound head trauma. American Association of Neurological Surgeons website. Available at: Accessed May 13, 2016.

Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at: Updated April 21, 2016. Accessed May 13, 2016.

Traumatic brain injury & concussion. Centers for Disease Control and Prevention website. Available at: Updated February 9, 2016. Accessed May 13, 2016.

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