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


Penetrating brain injury is when an object enters the skull and harms the brain. It can hurt a small or large part of the brain. The injury is a threat to life. You will need 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.


The injury may be from any object or outside force, such as:

  • A fall, which could cause a piece of the skull to break off and enter the brain
  • A motor vehicle accident
  • A gunshot
  • A stab wound
  • A sports injury
  • Abuse, such as being struck on the head with an object

Risk Factors

This injury is more common in older adults because they may fall. It is also more common in younger adults due to the risk of motor vehicle accidents.

Other things that raise your risk are:


Symptoms depend on what caused the injury and how badly you are hurt. You may have:

  • Heavy bleeding from the head
  • Bleeding from the ears
  • Problems breathing
  • Seizure
  • Loss of bowel and bladder function
  • Loss of movement or feeding in the limbs
  • Loss of consciousness
  • Coma may occur after the injury


The doctor will examine you right away in the emergency room. This may mean checking:

  • Your heart and lungs
  • How alert you are
  • Reflexes, strength, and feelings
  • Your 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 your health is stable


Your treatment depends on a number of things, such:

  • How badly you are injured
  • The parts of your brain that were hurt
  • Your symptoms

Initial Treatment

The staff will first try to stabilize your health. If there is bleeding, steps will be taken to stop it right away. You may need 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 your blood pressure stable.


A neurosurgeon may need to:

  • Remove skull pieces that broke off—A bullet or other object may also need to be removed
  • Remove part of the skull—The brain often swells after a severe injury. Removing a part of the skull gives it room to expand
  • Make burr holes in the scalp and skull to drain clotting blood from a hematoma .
  • Place a tube into the brain to drain fluid

The doctor may also put monitoring devices in the brain to check the:

  • Pressure in the brain
  • Temperature of the brain and the oxygen levels


Seizures may happen. The doctor may give you antiseizure medicines. Strong pain relievers, like opioids, may be given through an IV.


After your health has improved, the doctors will create a program that may mean 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 you get back as much function as possible.


Here are ways to prevent this type of injury:

  • 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 setting.


American Academy of Neurology  https://www.aan.com 

Brain Injury Association of America  http://www.biausa.org 


Brain Injury Canada  http://braininjurycanada.ca 

Ontario Brain Injury Association  http://obia.ca 


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 June 22, 2018.

Concussion and mild traumatic brain injury. EBSCO DynaMedPlus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T116529/Concussion-and-mild-traumatic-brain-injury  . Updated June 11, 2018. Accessed June 22, 2018.

Cranial gunshot wounds. UCLA Health website. Available at: http://neurosurgery.ucla.edu/cranial-gunshot-wounds. Accessed June 22, 2018.

Glasgow coma scale. University of North Carolina at Chapel Hill website. Available at: http://www.unc.edu/~rowlett/units/scales/glasgow.htm. Accessed June 22, 2018.

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 June 22, 2018.

Moderate to severe traumatic brain injury. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T900588/Moderate-to-severe-traumatic-brain-injury  . Updated April 19, 2018. Accessed June 22, 2018.

Traumatic brain injury & concussion. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/traumaticbraininjury. Updated July 6, 2017. Accessed June 22, 2018.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 05/2018
  • Update Date: 06/22/2018