Gunshot Wounds to the Head in Civilian Practice (original) (raw)
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Management of gunshot injuries to the head and brain
2010
Craniocerebral gunshot wounds are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is 52-95% depending on the proportion of suicide victims in the series. The devastating nature of this lesion is accentuated by the fact that predominantly affects young and healthy patients. The most important predictive factor is the post-resuscitation Glasgow Coma Score (GCS). Early aggressive resuscitation, surgery and vigorous control of intracranial pressure offers the best chance of achieving a satisfactory outcome. In this paper the authors performed a critical literature review about this issue and discuss the clinical aspects and management in these patients.
Neurosurgical Review, 2012
This study was carried out to evaluate the early results and the prognostic factors affecting the outcome during the in-hospital stay of 110 patients with civilian gunshot wounds to the head admitted at the Hospital of Restauração, Recife, Brazil. Penetrating injury (66%) was the most prevalent type of wound encountered in the present series. Twelve of the 110 (10.9%) patients presented a unilateral dilated pupil at the admission. Motor impairment was present in 24/110 (21.8%) patients. Intracerebral hematoma was present in 36/110 (32.7%) and there were 15/110 (13%) patients with cerebrospinal fluid fistula. Eleven of 110 patients developed meningitis and in 9/110 intracranial abscesses occurred. Nine of 110 patients developed deep venous thrombosis, 11/110 had urinary infection, and coagulopathy was detected in 8/110. Following the surgical procedure, 27/110 (24.5%) patients died during their hospital stay. When the two groups, survivors and non-survivors, were compared, there were significant statistical differences and the univariate analysis identified five preoperative predictors of a poor outcome following surgery: age over 40 years (odds ratios (OR) 5.4, 95% CI 1.73-16.82); presence of unilateral pupil dilatation (OR 5.5, 95% CI 1.641-18.13); low (≤8) Glasgow coma score on admission (OR 6.50, 95% CI 2.27-18.60), presence of intracranial hematoma (OR 3.0, 95% CI 1.21-7.34), and respiratory infection (OR 4.8, 95% CI 1.75-13.47). Thus, (a) age of the patient (juvenile/young age), (b) high preoperative Glasgow coma score, (c) lack of pupil abnormalities, and (d) absence of intracerebral hematoma are predictors of a good prognosis.
Civilian gunshot wounds to the head: a case report, clinical management, and literature review
Background: Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion. Gunshot wounds to the head are the deadliest of all gun injuries. According to literature statistics, the survival rate of patients with gunshot wounds to the head is only 9%. Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost entirely based on military experience, and there are few related reports, especially of the head, in which an individual suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time. Case presentations: We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances. On initial presentation, the patient had a Glasgow Coma Scale score of 6, was unable to communicate, and had loss of consciousness. The first bullet penetrated the right frontal area and finally reached the right occipital lobe. When the patient reflexively shielded his head with his hand, the second bullet passed through the patient's right palm bone, entered the right frontotemporal area, and came to rest deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan. After two foreign body removals and skull repair, the patient recovered completely. Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital, followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is usually necessary, and its key points include the timing, method, and scope of the operation.
IP innovative publication pvt. ltd, 2019
Introduction : Surgeons face unique challenge in the management & prognosis related issues with intracranial gunshot injuries. These injuries are more commonly seen in military conflict zone. With easy availaibility of weapon and increase in the conflict between civilian and paramilitiary forces, clinician are facing more numbers of civilian gunshot injuries. In India the presentation and prognosis of gunshot injuries is different as many of these gunshot injuries are by country made weapons. Country made weapons have low velocity and caliber; henceforth the outcome and the management issues are different. We present our experience with 23 patients who sustained intracranial gunshot injuries, and identify the factors determining the outcome and management Material and methods: From March 2016 to September 2019 data was collected from 23 cases who were treated for intracranial gunshot injuries in Department of Neurosurgery at J. N. Medical College, Aligarh. History, type of weapon used, clinical condition and radiological findings were noted. Outcome was assessed by Glasgow’s Outcome scale. Results: Overall mortality was 26.08% (6/23). Of the 4 patients in GCS (3-7) group there was 100% mortality. Of the 5 patients in GCS group (8-12) mortality was 2 and one patient in persistent vegetative stage. All patients survived in GCS group (13-15). 5 patients underwent surgery; there was one mortality in the surgical group. Better outcome was noted in single lobe involvement and trajectory involving supratentorial noneloquent areas. Conclusion : Early aggressive resuscitative measures may help in better management. GCS at presentation is the most important factor affecting outcome. CT scan offers to be an important predictor of prognosis and also help in planning the management. Suicidal wound, hypotension and midline shift has poor prognosis. We don’t recommend aggressive exploration of the bullet tract & pellet removal for every patient.
A national survey of neurosurgical care for penetrating head injury
Surgical Neurology, 1991
Kaufman HH, Schwab K, Salazar AM. A national survey of neurological care for penetrating head injury. Surg Neurol 1991;36:370-7. We report results of a survey on the management patterns of penetrating head injury (PHI). American neurosurgeons (N = 2969) were asked to participate in a mail survey. One thousand one hundred twenty-eight responded, providing detailed information about their practices, their opinions concerning diagnostic testing, nonoperative therapy, and surgical debridement for PHI.
Penetrating brain injury: a case report
Anestezjologia Intensywna Terapia, 2015
Background: Gunshot wounds as a result of attempted suicide, criminality or warfare comprise a significant group among penetrating injuries of the brain. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high, up to 98.5%. Although there are also many other prognostic factors for high mortality, such as damage to the ventricular system or the involvement of two or more lobes, GCS score seems to be the most important determinant. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improve the prognosis and final outcome. Case report: The authors present the case of a 27-year-old man who suffered a gunshot wound to the right temporal region, self-inflicted from an airgun. On admission to the intensive care unit he received a score of 3 points on the GCS. There were also other negative prognostic factors-the pellet penetrated two lobes and damaged the third ventricle. Despite the serious prognosis, the appropriate multiprofile treatment and rehabilitation resulted in unexpectedly good recovery. Two years after the trauma the patient was conscious, maintained logical verbal contact, and was able to walk using a walking-aid. Conclusion: Rapid transport to a major trauma center is essential for patients with penetrating brain injury. Among all interventions it seems essential to provide the prevention of posttraumatic nervous tissue damage and associated neurological dysfunction.
Nonsurgical Management of the Brain’s Trauma in the University Hospital of Brazzaville
Neuroscience and Medicine, 2016
The aim of this study was to evaluate the medical management of traumatic brain injury. We performed a retrospective and descriptive study during the period from 1 st January 2014 to 31 st December 2015 (24 months), into the surgical department of the University Hospital of Brazzaville. 167 cases of non-operated traumatized brain have been identified. The average age was 29.84 years. The sex ratio was 8.82. Accidents on public roads were responsible for injury in 88.2% of the cases. 46.71% of patients had a moderate traumatic brain injury while 10.18% had a severe traumatic brain injury. Radiological evaluation was highlighted for the brain contusion in 52.09% of the cases. Tracheal intubation and ventilation were completed only in 6 out of the 17 cases of severe traumatic brain injury. Prevention of post-traumatic seizure was performed with the use of phenobarbital or sodium valproate. Mannitol was used for its osmotic properties. The outcome was favorable in 55.68% of the cases. The most common complications were pulmonary infections, persistent neurological disorders, urinary infection and hyponatremia. Mortality was recorded at 13.77%. Nonsurgical management of traumatic brain injury involves an expansion of the ventilatory assistance indication at all severe traumatic brain injuries, the fight against infectious complications and ionic monitoring.