Outcome of self-inflicted gunshot wounds of the brain

Department of Emergency Medicine, Methodist Hospital of Indiana, Inc, Indianapolis.
Annals of Emergency Medicine (Impact Factor: 4.68). 04/1988; 17(3):247-53. DOI: 10.1016/S0196-0644(88)80117-3
Source: PubMed


A consecutive series of 67 patients who had sustained self-inflicted gunshot wounds of the brain was reviewed retrospectively to evaluate factors determining outcome. Weapon caliber, site of bullet entry, degree of brain wounding on computerized tomographic scan, and presenting Glasgow Coma Scale (GCS) score were examined. Overall mortality, degree of disability in survivors, and survival time after injury in fatally wounded patients were assessed. Ninety-eight percent of all patients with an initial GCS score of 8 or less died. When the GCS score was more than 8, 91% of patients survived (P less than .0001). Survival rate was significantly increased in patients with injury limited to one lobe of the brain, compared with patients with brain wounds of greater severity demonstrated on computerized tomographic scan (P less than .05), while a missile crossing both vertical anatomic planes of the brain or coming to rest in the posterior fossa was lethal in 100% of cases. Survivors scored relatively well on the Glasgow Outcome Scale. Almost all (98%) fatally injured patients maintained vital functions for a time ample for transportation and evaluation at a major referral center. These findings hold important implications for trauma center and critical care resource allocation as well as organ transplantation programs.

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    • "Gunshot injuries (GSI) to the cranial area have an extremely high mortality rate ranging from 51% to 84% (1,2,3,4,5). The most important prognostic factors affecting mortality rate are the course of the bullet and the Glasgow Coma Scale (GCS) score at the time of initial evaluation (6). Respiratory and circulatory status at presentation, the diameter and reactivity of the pupils, and the presence or absence of coagulopathy constitute the other prognostic factors. "
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    ABSTRACT: Gunshot injuries (GSI) of the cranial area have an extremely high mortality rate. Herein, we present a girl who has been living with a bullet in the posterior sellar region. A 6-year-old girl was admitted with complaints of headache, polyuria and polydypsia, which started after a GSI. At the time of admission the patient’s anthropometric, physical and neurological examinations were normal. Urine output was 5.5 L/m2/24h. A water deprivation test suggested central diabetes insipidus, which responded to treatment. Evaluation of other pituitary hormones revealed central hypothyroidism and growth hormone deficiency. Pituitary hormone deficiency must be kept in mind in patients injured by a gunshot to the sellar/parasellar region. Conflict of interest:None declared.
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    ABSTRACT: The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms used were those commonly available to civilians, ranging from a .22 revolver to a .45 semiautomatic pistol. Missle tracks were measured and the volume computed. The relatively low-velocity missles produced by these weapons to not create the devastation that characterizes wounds from high-velocity military firearms. Instead, there is much variation in the size of the missle tracks, and they cannot be directly related to caliber. Pressure marks and contusions, impaction of bone chips, internal richochet, and cerebral edema occurred frequently. The missle passed through the brain completely in very case but was retained by the skull or soft tissues in a large percentage of cases. The mechanism of death may be acute pressure on the brain stem from the passage of the missle through the brain.
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    ABSTRACT: Radiologists can contribute substantially to the evaluation and treatment of the patient with a gunshot wound. Plain films, CT, angiography, and sometimes MR imaging are used to localize the missile, determine what path it followed in the body, assess missile and bone fragmentation, and identify missile emboli. If the peritoneal cavity was entered by a bullet, a laparotomy is required. Missiles subject to magnetic forces can complicate MR imaging. Certain locations of missile fragments predispose to lead poisoning or lead arthropathy. Angiography is useful for both diagnosis and treatment. Both angiographic hemostasis and percutaneous foreign body removal may be used.
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