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The Brain  
Brain nerve pathways

When a penetrating brain injury occurs, one area of the brain may be damaged or a larger region.

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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.

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Causes  

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

  • Fall (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)
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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
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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 ( paraplegia )
  • Loss of consciousness (A coma may occur after the injury.)
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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.)
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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 ( 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 medicines. Strong pain relieving medicines, like opioids, may be given through a vein in the arm.

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.