This document summarizes a study of 8 cases of transcranial stab wounds. Frontal stab wounds had the lowest morbidity and mortality, with patients usually recovering fully. Temporal stab wounds were often fatal. Two cases of trans-orbital stabs resulted in carotid-cavernous fistulas. The mechanisms of injury differ from other head injuries due to the focal damage along the tract. Early recognition is important for treatment. However, recognition can be difficult if the weapon is withdrawn, highlighting the medicolegal importance of distinguishing these types of wounds.