Penetrating head injuries to the skull and brain are relatively uncommon, especially those not involving projectiles, accounting for only about 0.4%of all head injuries. In Japan, because of very strict gun laws, missile wounds are rarely seen, so penetrating head injuries from this cause are especially uncommon. We here investigated a series of non-projectile cases, focusing on medical examinations including radiological examinations and treatment because sometimes such injuries may be misdiagnosed. We here describe 10 cases suffered penetrating head injuries not due to missiles, diagnosed at our hospital over a period of 25 years (1979–2004). The following data were reviewed retrospectively: 1) penetrating foreign body, the route of penetration; 2) neurological findings on admission; 3) CT scan results; 4) angiography findings; 5) use of preclusive antibiotics, presence or absence of meningitis; 6) surgical intervention; 7) presence or absence of seizure; 8) outcome.

In our cases, all were examined on CT scans as the initial method, and pneumocephalus (intracranial air) was one distinctive feature. In the cases in which parts of the penetrating foreign bodies remain, their removal should be performed if safe, and broad-spectrum antibiotics should be applied because intracranial infections occur at a high rate.