Abstract
Background
Patients with penetrating head trauma that crosses the midline of the brain have a
high mortality rate; most die in the prehospital setting or during initial resuscitative
efforts. However, surviving patients are often neurologically intact and several factors
other than bullet path, including post-resuscitation Glasgow Coma Scale, age, and
pupillary abnormalities, must be considered in aggregate when prognosticating patients.
Case Report
We present a case of an 18-year-old man who presented unresponsive after a single
gunshot wound to the head that traversed the bilateral hemispheres. The patient was
managed with standard care and without surgical intervention. He was discharged from
the hospital neurologically intact 2 weeks after his injury. Why Should an Emergency
Physician Be Aware of This? Patients with such apparently devastating injuries are
at risk of premature termination of aggressive resuscitative efforts based on clinician
bias that these efforts are futile and that patients cannot recover to a neurologically
meaningful outcome. Our case reminds clinicians that patients with severe injury patterns
with bihemispheric involvement can recover with good outcomes, and that bullet path
is only one variable among multiple that must be considered to predict clinical outcome.
Keywords
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References
- Surveillance for traumatic brain injury-related deaths—United States, 1997-2007.MMWR Surveill Summ. 2011; 60: 1-32
- Penetrating traumatic brain injury: a review of current evaluation and management concepts.J Neurol Neurophysiol. 2015; 61000336https://doi.org/10.4172/2155-9562.1000336
- Penetrating bihemispheric traumatic brain injury: a collective review of gunshot wounds to the head.World Neurosurg. 2017; 104: 653-659
- Prognostic factors and treatment of penetrating gunshot wounds to the head.Surg Neurol. 2003; 60: 98-104
- Predictors of outcome in civilian gunshot wounds to the head.J Neurosurg. 2014; 120: 1138-1146
- Civilian gunshot wounds to the head: prognostic factors affecting mortality: meta-analysis of 1774 patients.J Neurotrauma. 2018; 35: 2605-2614
- Predictors of outcome in civilians with gunshot wounds to the head upon presentation.J Neurosurg. 2014; 121: 645-652
- Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome.Neurosurgery. 2005; 57: 737-747
- The role of early surgical intervention in civilian gunshot wounds to the head.J Trauma. 1992; 32: 398-400
- Improving survival rates after civilian gunshot wounds to the brain.J Am Coll Surg. 2014; 218: 58-65
Article info
Publication history
Published online: December 26, 2022
Accepted:
December 13,
2022
Received in revised form:
November 10,
2022
Received:
October 6,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
Published by Elsevier Inc.
