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Open Head Traumatic Brain Injury (TBI)

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An open head traumatic brain injury (TBI) is a wound caused by an object (knife, screwdriver, nail, etc.) that breaks the skull and penetrates the meninges (three membranes), which surround the brain, and the brain itself. When the penetrating object exits through a location in the skull different from its entrance, it is called a perforating open head injury.

Many open head injuries are caused by another party's carelessness. When people are harmed under these circumstances, they may be entitled to compensation for medical expenses and other damages. If you suspect your head injury or that of someone you love was someone else's fault, contact a personal injury attorney to learn about your legal rights.

In this article you will learn about what causes various types of open head traumatic brain injuries, how they are diagnosed and treated and their prognosis.

Causes of Open Head TBI

An open head injury results from laceration, compression, strains and stretches, and destruction of brain tissue. Open head injuries are most often associated with the following kinds of accidents:

  • Workplace mishaps
  • Sports accidents
  • Military incidents
  • Child cruelty
  • Assaults (knifings and shootings)

In addition, open head injuries can be caused by motor vehicle accidents involving drunk driving. Learn more about DUI laws and penalties by visiting our DUI section.

Types of Open Head TBI

There are two types of open head TBI: primary and secondary. A primary injury occurs at the time of impact and penetration. Afterward, secondary injuries (various processes and changes in the brain) may be triggered and brain damage may occur.


Primary Injuries

  • Skull fracture. Four different types of skull fracture can occur: linear (a crack that doesn't ultimately collapse the skull), depressed (a break that results in pieces of the skull pressing into or penetrating the brain), diastatic (breaks along the skull plates' fuse lines — more common in small children than in adults) and basilar (breaks at the base of the skull, resulting from whiplash). Signs of fracture include bleeding from the ears and nose as well as symptoms related to the brain functions affected.
  • Concussion. A head concussion is a transient interruption of brain function, characterized by temporary unconsciousness, disorientation and memory loss (amnesia). Dizziness, headache, nausea, vomiting, blurred vision, nervousness, shock, and a quickening pulse rate may also be present. Serious symptoms include sustained disorientation or sleepiness, amnesia, speech problems, signs of paralysis, dilation of a pupil and coma.
  • Epidural Hematoma. An epidural hematoma is the formation of a blood clot between the skull and the dura mater (outer layer of membrane protecting the brain) caused by a tear in the middle meningeal artery or other blood vessels.


    A period of lucid consciousness followed by a lapse into unconsciousness is a first indication of an epidural hematoma. Symptoms associated with the interval of consciousness include nausea, dizziness, headache, vomiting, weakness in an arm or leg, and back pain. As the epidural hematoma grows, putting pressure on the brain, symptoms expand to include vision problems, numbness, speech problems, coordination problems, confusion, seizures, sleepiness, unconsciousness and coma.
  • Subdural hematoma. A subdural hematoma is the formation of a blood clot between the dura mater (outer layer of membrane protecting the brain) and the arachnoid (middle layer of membrane protecting the brain) caused by the laceration of fragile tissue as a result of brain movement within the skull. Indications of a subdural hematoma include nausea, headache, vomiting, confusion, amnesia, unconsciousness, loss of feeling in an arm or leg, walking difficulties, vision problems and coordination problems.
  • Intraventricular hemorrhage. An intraventricular hemorrhage occurs when blood flows into the brain's inner chambers, where cerebrospinal fluid (a water-like fluid) is produced. Indications include, among others, persistent headache, inability to walk, inability to think and difficulties controlling urination.
  • Subarachnoid hemorrhage. A subarachnoid hemorrhage is bleeding between the brain and the arachnoid membrane (middle of three membranes protecting the brain). Indications consist of nausea, vomiting, headache, unconsciousness, inability to concentrate, confusion, problems coordinating, problems seeing, and numbness.
  • Contusion. A contusion, or bruise, occurs when blood vessels break, causing swelling that has the potential to damage neurons (nerve cells). Bruises can expand and combine with one another. When this happens, an intracranial hematoma (blood collecting within the brain) can occur.


    Symptoms differ depending on the area of the brain where the bruise occurs and the size of the bruise. Small bruises in regions of the brain that do not control specific bodily functions may not display signs. However, widespread bruising in areas of the brain that control bodily functions may show a variety of symptoms and cause lasting damage, interfering with, among others, the ability to see, remember and coordinate. Contusions can lead to coma and death.
  • Diffuse axonal injury. A diffuse axonal injury refers to harm done to nerve fibers across the whole of the brain as a result of the brain shaking back and forth and rotating in the skull. Such an injury, which is often lasting, causes loss of consciousness and can end in coma and death.

Secondary Injuries

Secondary injuries include, among others, the following:

  • Edema, or swelling of brain tissues caused by an increase in water content
  • Ischemia, a lack of blood flow to the brain
  • Increased intracranial pressure (ICP), or pressure growing inside the skull as a result of swelling brain tissue or collecting fluid
  • Infection, a harmful intrusion of bacteria
  • Epilepsy, which causes seizures characterized by involuntary shaking and/or unconsciousness
  • Hydrocephalus, excessive fluid buildup inside the brain
  • Vasospasm, the spontaneous narrowing or contracting of blood vessels

Diagnosing and Treating Open Head Injuries

Diagnosing and treating an open head injury go hand in hand. Diagnostic techniques include, among others, the following:

  • Neurological/physical examination
  • Blood tests
  • The Glasgow Coma Scale
  • The Rancho Los Amigos Scale
  • Electroencephalogram (EEG)
  • Imaging (X-ray, CT scan, MRI, Angiography)

Degree of Brain Damage

The amount of initial brain tissue destroyed in an open head type of traumatic brain injury depends largely on the size of the cavity produced in the brain by the penetrating object. If the wound is caused by a low-velocity impact, the injury may be focal, causing harm to only one area of the brain. However, in the case of a high-velocity intrusion, as from a bullet, shockwaves may spread damage across the whole of the brain (this type of damage to the brain is called diffuse brain damage).

The physical harm done by an open head injury depends on the:

  • Characteristics of the penetrating object (knife, bullet, etc.)
  • Force of penetration (high-velocity or low-velocity)
  • Angle and path of penetration
  • Site(s) of trauma


The Glasgow Coma Scale is a fairly reliable measurement of the extent an open head TBI patient will recover. Possible outcomes include the following:

  • Mild disability, which usually occurs when a patient avoids loss of consciousness or loses consciousness for a short period of time. A diagnosis of mild disability indicates the likelihood of a full recovery.
  • Moderate disability, which typically occurs when a patient experiences a period of unconsciousness lasting longer than 30 minutes, often requires rehabilitation but carries a high likelihood of recovery.
  • Severe disability, characterized by a coma, indicates less likelihood of recovery. Recovery from a coma often depends upon how long the coma lasts. Ongoing care is often necessary.
  • Vegetative state
  • Death

If you or a loved one has suffered an open head injury, it is important that you speak with a lawyer in order to protect your legal rights and determine if you might be eligible for compensation in the form of a settlement or court award.