Brain injury by firearm projectile

Case contributed by Guilherme Pioli Resende
Diagnosis certain

Presentation

Patient admitted in an unconscious state due to brain injury caused by a firearm projectile. Surgically treated emergently before imaging.

Patient Data

Age: 25 years
Gender: Male

Exam performed three days after the traumatic event, after the surgical procedure. Firearm projectile wound in the left cerebral hemisphere, with bullet lodged in the soft parts overlying the craniectomy, in the meningogaleal complex and in superficial temporal, parietal and occipital parenchymal portions. Extensive area of​ hypodensity, with loss of definition of the cerebral grooves, ventricular compression, small deviation of the midline and herniation of the parenchyma (craniectomy). Hemorrhagic foci on the left parietal and temporal lobes.

3 months later

ct

Areas of extensive encephalomalacia/gliosis are observed, affecting the left cerebral hemisphere (sequelae), associated with ventricular dilation and ectasia of the homolateral grooves and fissures.

Case Discussion

Left frontoparietotemporal decompression craniectomy was performed. Analyzing the evolution of the image aspect evidenced in the exams, it is possible to notice a reduction in the size and degree of attenuation of the hemorrhagic areas on the left parietal parenchyma due to probable metabolism in the hematic components, also, there is a significant brain morphological alteration.

Contributed by Dr. Hemilianna Hadassa Silva Matozinho M.D.

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