With the dearth of trained neurosurgeons in sub-Saharan Africa and increasing civilian violence, penetrating head trauma occasionally present to other clinicians for management. The National Orthopaedic Hospital, Enugu is a non-neurologic trauma centre having the south-east, south-south geopolitical zones, and parts of Benue and Kogi states as the catchments area. A retrospective report from the case note of a patient with infratentorial brain injury from a gunshot is presented. He was treated conservatively and had a satisfactory outcome. The follow up is for four years. Adequate resuscitation and monitoring is crucial in successfully managing head injuries.