Gunshot Wounds of the Head and Brain

Czech version

Authors: M. Sova ¹; M. Duba ¹; V. Vybíhal ¹; A. Šprláková ²; L. Juříček ³
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno ¹; Radiologická klinika LF MU a FN Brno ²; Univerzita obrany Brno ³
Published in: Cesk Slov Neurol N 2010; 73/106(5): 547-551
Category: Short Communication

Overview

Aim:
The authors report the results of treatment to patients with gunshot and captive bolt injury to the brain, all of them undergoing surgery at the Department of Neurosurgery at the Faculty Hospital, Brno in the 2005–2008 period. The article addresses the most important prognostic factors influencing choice of therapeutic procedures. It also includes a classification and pathophysiology of penetrating injuries. The authors present a basic survey of the impact ballistics of gunshot injuries.

Patient group and methods:

The case histories of 20 patients were subjected to operational review. All of them were male, mean age 59, range 33–80 years. Attempts at suicide accounted for 17 of the them; two arose out of negligent handling of a firearm; and one patient was a victim of violent crime. The clinical status of the patients was retrospectively evaluated by means of the Glasgow Outcome Scale [1], 6 months after the penetrating injury on the part of the survivors. The dependence of GOS on the patient’s state of consciousness on admission and the extent of brain involvement according to CT scan were evaluated.

Results:
The patient’s state of consciousness on admission and the extent of brain parenchyma damage on CT scan are the most important prognostic factors dictating approaches to the treatment of these severely injured patients. In our group, the initial Glasgow Coma Scale [2] points totalled 3 in 15 patients (75%), 9 in 1 patient (5%), 14 in 1 patient (5%) and 15 in 3 patients (15%). Initial presenting examination of the brain with computer tomography revealed 9 cases of severe, extensive, multilobar involvement of the brain parenchyma, 11 cases of focal involvement of a single lobe, often in the “eloquent” brain. Mortality in the whole group reached 65%, and 4 cases were classified as donors to the transplantation program.

Conclusion:
The specialist literature indicates that the mortality rate of brain gunshot wounds varies between 60% and 90%, and our group suffered a mortality of 65%. This relatively favourable outcome is determined by the fact that 50% of the wounds were inflicted by a slaughterhouse (captive bolt) gun, which lacks the extended penetration of bullet-firing weapons. Despite the fact that serious primary injury to the brain parenchyma occurs, a favourable prognosis may result from emphasis on minimizing further secondary brain damage.

Key words:
penetrating head injury – gunshot head injury

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