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].

• 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]

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].

In our review, treatment steps were similar among various institutions and resembled recently suggested algorithms, with better treatment outcomes than originally reported 30 years ago. [ncbi.nlm.nih.gov]

The treatment of penetrating brain injuries will involve treatment of the TBI caused by the penetrating object similar to the treatment of closed head injuries. [rehabchicago.org]

The clinical presentation depends on the site and extent of the injury, but the overall prognosis is much poorer compared to injuries caused by blunt force trauma. [symptoma.com]

The prognosis of such severe trauma could be influenced very positively by a good medical care organization; obviously, the extent of brain tissue laceration is the limiting factor. [ncbi.nlm.nih.gov]

[…] injury or to relieve excessive intracranial pressure. [4] Intracranial pressure is monitored and attempts are made to maintain it within normal ranges. [4] Intravenous fluids are given and efforts are taken to maintain high blood oxygen levels. [4] Prognosis [ipfs.io]

Treatment and prognosis Unsurprisingly, mortality is high. In civilian shootings, approximately 20% survive the initial injury, and of those, ~50% (range 30-68%) survive 2. [radiopaedia.org]

Glass, knife, wood, metal splinters and bullet injuries are the some examples in the etiology of these injuries [1-4]. [austinpublishinggroup.com]

In cities with populations greater than 100,000, assaults, falls, and penetrating trauma are more common etiologies of head injury. The male-to-female ratio for TBI is nearly 2:1, and TBI is much more common in persons younger than 35 years. [emedicine.medscape.com]

Inconsistency in the definition and classification of traumatic brain injury (TBI), along with discrepancies in data collection, has made the epidemiology of TBI difficult to describe accurately. [emedicine.medscape.com]

"Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Retrieved on February 6, 2007. ↑ O'Leary, R.; McKinlay, J. (2011). "Neurogenic pulmonary oedema". [ipfs.io]

Epidemiologically, penetrating head injury (PHI) and trauma, in general, affect a younger demographic worldwide, and as a result such injury carries a high socioeconomic burden. [clinicalgate.com]

This case report describes a patient with a penetrating injury to the head and brain from a gunshot wound including the pathophysiology of injury and outlines evidence-based management guidelines to provide comprehensive care. [uthealth.influuent.utsystem.edu]

"Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Retrieved on February 6, 2007. ↑ O'Leary, R.; McKinlay, J. (2011). "Neurogenic pulmonary oedema". [ipfs.io]

The strategy for treatment of NPO is to reverse the pathophysiological disturbance while supporting organ function. [ceaccp.oxfordjournals.org]

Pathophysiology Appropriate management of TBI requires an understanding of the pathophysiology of head injury. In addition to the obvious functional differences, the brain has several features that distinguish it from other organ systems. [emedicine.medscape.com]

That is, all efforts must be made to prevent any secondary insults, hypoxia, or ischemia. This translates into the standard methodology of care of the trauma patient. [ncbi.nlm.nih.gov]

Ozcomert pursue the compensation you deserve if you have suffered one of these preventable accidents. Motor Vehicle Accidents Serious car crashes can provide the external force necessary to penetrate the skull and cause severe head injuries. [atlantapersonalinjurylawyer.pro]

If this is not controlled or prevented the brain can herniate (push through) the base of the skull and cause respiratory failure and death. The only way to prevent the primary injury is to prevent the trauma. [traumaticbraininjury.com]

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.