Head Trauma, Penetrating

Head Trauma, Penetrating is a topic covered in the 5-Minute Emergency Consult.

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Penetrating injury to intracranial contents:
  • High-velocity penetration: Usually bullets, which cause trauma directly to brain tissue and also have a “shock wave” injury to local surrounding brain
  • Low-velocity penetration: Usually knives, picks, or other sharp objects, with direct local trauma to brain tissue


  • Direct penetration of the skull into the intracranial cavity by foreign object:
    • Direct or local damage to brain tissue
    • Intracranial hemorrhage, including subdural, epidural, and intraparenchymal bleeds
  • A bullet that hits the skull, ricochets off, and does not fracture the skull can still cause significant trauma to the underlying brain tissue.

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