Neurologically Intact Survival after Bihemispheric Penetrating Head Trauma: A Case Report

Published:December 26, 2022DOI:



      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Coronado V
        • Xu L
        • Basavaraju S
        • et al.
        Surveillance for traumatic brain injury-related deaths—United States, 1997-2007.
        MMWR Surveill Summ. 2011; 60: 1-32
        • Van Wyck D
        • Grant G
        • Laskowitz D.
        Penetrating traumatic brain injury: a review of current evaluation and management concepts.
        J Neurol Neurophysiol. 2015; 61000336
        • Turco L
        • Cornell D
        • Phillips B.
        Penetrating bihemispheric traumatic brain injury: a collective review of gunshot wounds to the head.
        World Neurosurg. 2017; 104: 653-659
        • Martins R
        • Siqueira M
        • Santos M
        • Zanon-Collange N
        • Moraes O.
        Prognostic factors and treatment of penetrating gunshot wounds to the head.
        Surg Neurol. 2003; 60: 98-104
        • Aarabi B
        • Tofighi B
        • Kufera J
        • et al.
        Predictors of outcome in civilian gunshot wounds to the head.
        J Neurosurg. 2014; 120: 1138-1146
        • Maragkos G
        • Papavassiliou E
        • Stippler M
        • Filippidis A.
        Civilian gunshot wounds to the head: prognostic factors affecting mortality: meta-analysis of 1774 patients.
        J Neurotrauma. 2018; 35: 2605-2614
        • Gressot L
        • Chamoun R
        • Patel A
        • et al.
        Predictors of outcome in civilians with gunshot wounds to the head upon presentation.
        J Neurosurg. 2014; 121: 645-652
        • Kim K
        • Wang M
        • McNatt S
        • et al.
        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
        • Helling T
        • McNabney W
        • Whittaker C
        • Schultz C
        • Watkins M.
        The role of early surgical intervention in civilian gunshot wounds to the head.
        J Trauma. 1992; 32: 398-400
        • Joseph B
        • Aziz H
        • Pandit V
        • et al.
        Improving survival rates after civilian gunshot wounds to the brain.
        J Am Coll Surg. 2014; 218: 58-65