The effects of high velocity missiles are described. A series of cases of craniocerebral tangential gunshot wounds over a 6 year period is presented with unsuspected cerebral contusion shown by CT. Tangential wounds are defined and classified into four groups. The associated brain damage, often unsuspected prior to CT, and in some cases without radiographic changes, of the four groups is compared. The short- and long-term sequelae and the extent of cerebral damage belie the innocent appearance of the scalp wound. This influences the management of this unusual type of head injury.