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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.

Copyright © Nucleus Medical Media, Inc.

Causes

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 (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—paralysis
  • Loss of consciousness—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 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:

  • 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.

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 wound. New York Presbyterian Hospital website. Available at: http://nyp.org/health/cranial-gunshot-wounds.html. Accessed May 30, 2014.

Cranial gunshot wounds. University of California, Los Angeles Health System 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.

Neff D. Closed head injury. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated May 12, 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.



Last reviewed May 2014 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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