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An open head injury—sometimes known as an open wound brain injury—can be terrifying to witness. These injuries are often extremely bloody because of the large number of blood vessels that serve the brain. They are often life-threatening, but don't allow yourself to be intimidated by the appearance of an open wound brain injury. Some look much worse than they are, and you cannot judge the danger posed by an injury based on how bloody it is or how painful it looks.

Nevertheless, any open head injury warrants immediate medical attention at a local emergency room, and may require treatment at a facility that specializes in brain and spinal cord injuries. The more quickly you seek treatment, the better the prognosis will be.

By definition, an open head injury fractures the skull, and so is sometimes called a broken skull. Sometimes the skull cracks as a result of a sudden blow. In other cases, an object may puncture the skull. Understanding the wide variety of skull fractures, as well as the way these injuries can affect brain health, can help you better understand your injury, ask your doctor the right questions, and assess your prognosis.

What is an Open Head Injury?

Open head injuries occur when something hits the head forcefully enough to penetrate the skull. A minor bleed on the head—such as from getting punched or hitting your head on a desk corner—does not qualify as an open head injury. Instead, your skull must be penetrated by an object.

Some open head injuries merely penetrate the skull; while these can be life-threatening, they are typically far less dangerous than injuries that also penetrate the brain. When an object makes contact with the brain, permanent brain damage may be the result. Severe bleeding, blood clots, and other life-threatening injuries can also occur, so it's vital to seek emergency medical assistance. Never try to remove an object on your own, or adopt a “wait and see” approach. Even if you feel fine, your life might be in danger.

Types of Open Wound Brain Injuries

Most doctors differentiate between four different types of open wound brain injuries. Those include:

  • Linear skull fractures: Linear skull fractures, which account for the majority of head injuries, are typically the least serious. These injuries involve only a crack in the skull, without any penetration in the brain. Bleeding is usually minimal, but is largely dependent upon the location of the fracture. Many linear skull fracture survivors make full recoveries. Rarely, patients who have suffered another type of brain injury develop a linear skull fracture when swelling on the brain ruptures the skull. 
  • Diastatic skull fracture: Common among babies, diastatic fractures occur when the skull's regions are separated. Developing babies have lines in their skulls where the bones will ultimately fuse together, but some injuries separate these bones. Complications range from minor to life-threatening, but any head injury to a baby or young child is a serious medical emergency. 
  • Depressed skull fracture: These injury occur when the skull is penetrated, often by a sharp object, leaving broken pieces of the skull in contact with the brain. These injuries can cause severe brain damage, in addition to constricting major blood vessels. 
  • Basilar skull fracture: The rarest variety of skull fracture, basilar skull fractures occur when the base of the skull breaks. This can tear tissue that holds the brain in place, interfere with the brain's ability to communicate with the spinal cord, and cause cerebrospinal fluid to leak from the ears and nose.

Short-Term Symptoms of Open Wound Brain Injuries

Any open wound brain injury is a life-threatening medial emergency. Do not try to treat symptoms at home or adopt a wait and see approach. Instead, go to an emergency room—ideally at a trauma care hospital—immediately. If you're not sure whether you've suffered a skull fracture, some of the immediate symptoms include:

  • Bleeding from a head injury. 
  • Swelling near a head injury, or at other locations around the head. 
  • Loss of consciousness after a blow to the head. 
  • Changes in mood or personality. 
  • Confusion or difficult concentrating. 
  • Seizures. 
  • Nausea, vomiting, and intense headaches. 
  • Inability to stay awake. 

Long-Term Symptoms of Open Wound Brain Injuries

The long-term effects of an open wound brain injury vary greatly from person to person, and depend on factors such as the severity of the injury, the area of the brain injured, overall health, quality of medical care, and quality of follow-up care. For example, a healthy young person who continues with physical therapy has a much better prognosis than an older person in poor health who does not engage in physical therapy. Your doctor can give you the most accurate estimate of your prognosis, but some of the most common long-term effects of an open wound injury include:

  • Changes in appearance near the site of the injury. 
  • Changes in mood, personality, or mental health; some people struggle with depression, anxiety, or impulse control problems. 
  • Alterations in cognition and intelligence. 
  • Difficulty with fine or gross motor skills. 
  • Memory difficulties. 
  • Ongoing chronic pain and headaches. 
  • Secondary immune system reactions, including an increased general vulnerability to infections.

Treatment for Open Wound Brain Injuries

Immediate treatment for an open wound brain injury focuses on stopping the bleeding and, if possible, removing the object that caused the wound. Rarely, removal is more dangerous than leaving the object in place, so you should never try to remove a foreign object yourself. Many open wound brain injury survivors require several surgeries to cauterize blood vessels, treat skull fractures, and remove foreign objects.

From there, the recovery process depends on how severe the injury was. Some open wound brain injury survivors heal with little medical intervention; this is especially true of people who suffer only minor linear skull fractures. Other need years of follow up therapy and treatment. Those treatments may include:

  • Mental health counseling: Living with a brain injury can be demoralizing, and a brain injury itself can change your mood and personality. Psychotherapy—and sometimes psychiatric medications—make the transition easier.
  • Medications to address side effects of your injury; your doctor might put you on blood thinners to reduce the risk of a blood clot, or recommend antibiotics to prevent infections.
  • Physical, occupational, and speech therapy to help you regain lost functioning. This therapy helps your brain rewire itself to work around your injury, and the more frequently you go and harder you work, the more likely it is to be effective.
  • Education about your injury, especially education for your family and friends.
  • Follow-up surgeries to address problems associated with the injury, such as skull fragments or damaged blood vessels.
  • Ongoing brain scans and other testing to measure your progress and detect and address problems before they become more serious.

For more information about brain injuries, check out our free eBook, The Simplified Guide to Understanding a Brain Injury.