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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
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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Causes

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:

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:

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

Treatment

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 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 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

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

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:
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 May 30, 2014.

Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 22, 2014. Accessed May 30, 2014.

Cranial gunshot wounds. UCLA Health website. Available at: http://neurosurgery.ucla.edu/body.cfm?id=134. Accessed May 30, 2014.

Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at: http://www.unc.edu/~rowlett/units/scales/glasgow.htm. Updated May 30, 2014.

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 30, 2014.

Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 14, 2014. Accessed May 30, 2014.

Traumatic brain injury. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/traumaticbraininjury. Updated March 6, 2014. Accessed May 30, 2014.

Traumatic brain injury. New York Presbyterian Hospital website. Available at: http://www.nyppsychiatry.org/library/showDocument.php?contentTypeId=85&contentId=P01145&subtopicId=Rehabilitation&heading=Traumatic+Brain+Injury. Accessed May 30, 2014.

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