Penetrating traumatic brain injury

Case contributed by Dr Francesco Macri

Presentation

Man killed with a handgun shot at point black range to the forehead.

Patient Data

Age: 60-year-old
Gender: Male
CT

CT Brain (annotated)

Man sustained a handgun shot at very close distance. 3D images depict the bullet entry orifice at cutaneous and bone surfaces. The main bullet path was recognised by bone fragments, shrapnels and blood from the top downward at the right occipital side. A ricochet of a fragment of the bullet was identified by a blood track run out at left temporal area. No exit wound was found. 

Case Discussion

Man executed with a handgun shot to the head at very close range.

The trajectory from the top downward is not typical for a suicide (best depicted on sagittal images).

The bone table inward or outward beveling is typically indicative of the entry or exit wound respectively. In this case outward beveling (i.e. exit wound) was not present, because the bullet dissipated completely its kinetic energy crossing all skull structures. Thus the bullet had no more energy to break down the posterior bone wall of the skull. Line fractures and their features also give a lot of information about the first bone fracture according to the Puppe’s rule. 

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Case information

rID: 42071
Case created: 4th Jan 2016
Last edited: 21st Oct 2017
Inclusion in quiz mode: Excluded

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