Brain Injury

Definition

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. It is a threat to life and needs emergency care.

The Brain

Damage to the brain may be in one area or a larger region.

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Causes

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

Things that may raise the risk of this problem are:

• Having health problems that raise the risk of falls
• Alcohol use disorder
• Substance use disorder
• Being in a violent place
• Playing high impact sports
• Being in a motor vehicle accident

Symptoms

The problems a person may have depend on what caused the injury and how severe it is. A person with a penetrating brain injury may have:

• Heavy bleeding from the head
• Bleeding from the ears
• Problems breathing
• Seizure
• Bowel and bladder problems
• Problems moving
• Loss of feeling in the limbs
• Loss of consciousness

Diagnosis

The doctor will look at the injury in the emergency room. This is often enough to make the diagnosis. Life-saving treatment may be given at this time.

When the person is stable, images may be taken to look for damage in the brain and skull. This can be done with:

• X-rays
• CT scan
• MRI scan (only used when the penetrating object is not made of metal)

Treatment

Treatment depends on:

• How severe the injury is
• The parts of the brain that were hurt
• The symptoms the person is having

Initial Treatment

The first goal of treatment is to give any lifesaving care that is needed. This may involve stopping bleeding and helping with breathing.

Surgery

Surgery may be done to:

• Remove skull pieces that broke off
• Remove any objects, such as bullets
• Remove part of the skull to ease pressure from swelling
• Make holes in the scalp and skull to drain blood
• Place a tube into the brain to drain fluid

Medication

Medicine may be given to manage symptoms. Examples are:

• Antiseizure medicine
• Prescription pain medicine

Rehabilitation

Recovery will include rehabilitation, such as physical and occupational therapy.

Prevention

Most penetrating brain injuries are due to accidents that cannot be prevented.

Healthy bones and muscles may help prevent injuries from falls. A healthy diet and exercise can help build bones and muscles.

References

• Gunshot wound head trauma. American Association of Neurological Surgeons website. Available at: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Gunshot-Wound-Head-Trauma.
• Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/moderate-to-severe-traumatic-brain-injury.
• Surveillance report 2017: Head injury: assessment and early management NICE guideline CG176. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551813.
• Traumatic brain injury and concussion. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/traumaticbraininjury.