Bleeding from the scalp, visible skull fracture, and visible brain tissue are signs of an open head injury.

You may not be able to evaluate the seriousness of a head injury by its appearance. A lacerated scalp may appear to be very serious due to profuse bleeding, but the bleeding can be controlled with a dressing.

What appears to be a minor injury could be accompanied by injury to brain tissue that results in increased intracranial pressure, which can be fatal. The open wound may be a penetrating wound (entry wound with no exit wound) or a perforating wound (both an entry and an exit wound).