The clinical presentation strongly depends on the site and extent of brain injury [1] [2]. Although a small proportion of all head injuries are caused by penetrating objects, they pose a significant risk for the individual's life [3]. As the foreign body (either a high-velocity object such as a missile, or a lower-velocity object such as a knife) damages the brain and the vascular system, complications in the form of intracerebral hemorrhage, contusion, pneumocephalus, and even brain stem injury can be seen [3]. All of these events further predispose to infections of the central nervous system (CNS), namely to meningitis, encephalitis, and abscess formation [3] [4]. Infections may appear shortly after trauma, or weeks or months later, particularly if organic materials (for example wood) have remained in the cranium [3] [5]. All patients unequivocally show deficits in one of the three items of the GCS (eye-opening, verbal communication, and motor response). Studies show that individuals with very low GCS scores almost universally die of injuries or remain in a persistent vegetative state, indicating the poor prognosis of severe penetrating head injuries [5] [6]. Bilateral pupil dilation and markedly raised intracranial pressure are established as predictors of mortality [3] [5].

• Distractibility

  Collisions caused by negligent driving may involve: Speeding Intoxication Failure to yield Talking, texting High-risk driving Fatigue, distraction Georgia’s dram shop laws hold individuals and businesses responsible for serving alcohol to underage drivers [atlantapersonalinjurylawyer.pro]

  If a penetrating head injury occurred as a result of a car accident caused by a negligent, distracted or alcohol-impaired driver, you need to speak with a personal injury lawyer immediately. [coxwelllaw.com]

• Anhedonia

  Anhedonia was measured by self-report in each group using the four-item anhedonia subscale score of the Beck Depression Inventory-II. [ncbi.nlm.nih.gov]

• Dystonia

  Deep brain stimulation (DBS) has been a major advance in the treatment of dystonias. Outcomes are, however, less predictable for secondary dystonias, predominantly due to progression of disease or specific brain lesions. [ncbi.nlm.nih.gov]

• Neurologic Manifestation

  manifestations including cranial nerve abnormalities. [ncbi.nlm.nih.gov]

Penetrating head injuries require a prompt diagnosis and physicians need to recognize the symptoms and the obvious signs of this type of injury. For this reason, a physical examination coupled with a detailed patient history that reveals the circumstances and the mechanism of injury are crucial components of the workup. As soon as a presumptive diagnosis is made, imaging studies should be immediately employed. Plain radiography is a useful study that determines the extent of skull injury, the exact location of the missile and the residual bone fragments, but also confirms if there is the presence of air in the cranium [1] [2] [6]. However, computed tomography (CT) has emerged as a superior method for penetrating head injury evaluation and should be conducted whenever possible [1] [2] [3] [6]. It provides results within a short time span, possesses no risks, and allows more detailed assessment of the cranial structures [1]. Magnetic resonance imaging (MRI), on the other hand, is frequently contraindicated due to a very high risk of further brain damage that can be caused by a missile or some other object movement (if composed of metal) during this imaging procedure [1] [2] [3]. Another reason is a much longer turnaround time compared to CT scans and X-rays [1]. CT angiography or catheter angiography may be useful if vascular injury is suspected [1].

1. Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emerg Trauma Shock. 2011;4(3):395-402.
2. Karim T, Topno M. An unusual case of penetrating head injury in a child. Journal of Emergencies, Trauma and Shock. 2010;3(2):197-198.
3. Temple N, Donald C, Skora A, Reed W. Neuroimaging in adult penetrating brain injury: a guide for radiographers. J Med Radiat Sci. 2015;62(2):122-131.
4. Hettige S, Kok K, Epaliyanage P, Thomas NWM. Chopstick injury penetrating he skull base: a case report. Skull Base. 2010;20:219–222.
5. Singh A, Bhasker SK, Singh BK. Transorbital Penetrating Brain Injury with a Large Foreign Body. Journal of Ophthalmic & Vision Research. 2013;8(1):62-65.
6. Śmiłowska K, Pytel J, Krawczyk L, Śmiłowski M, Jałowiecki P. Penetrating brain injury: a case report. Anaesthesiol Intensive Ther. 2015;47(3):214-218.