1. Penetrating Brain InjuriesPenetrating Brain Injuries Jared Wutzke MSIV Diagnostic Radiology March 30, 2007

2. FromFrom Clinical Radiology 2Clinical Radiology 2ndnd ed.ed. It is a well-known fact that any GSW (gun shot wound) that crosses the midline of the cranium is fatal. In our practice we routinely obtain an AP skull radiograph on all cranial GSW patients to determine whether the bullet has traversed the midline. If this is the case, no additional studies are performed; if not, we proceed with cranial CT. 3. FromFrom International Journal of Legal Medicine.International Journal of Legal Medicine. 113(6):349-51, 2000.113(6):349-51, 2000. A 28-year-old man was shot in the back of the head at close range by a robber who then locked him in a room assuming that he was dead. The man was discovered 2 days later. The entrance wound of the bullet was in the left occipital region and it passed into the periphery of the right temporal lobe, where it lodged. The man was transferred to a rehabilitation center 3 weeks later in relatively good health with only slight general EEG changes. The mild clinical course in this case is attributable to two major factors: firstly, no important brain structures were injured, and secondly, the kinetic energy of the silver-tip hollow-point bullet was probably rather low. Three years after the incident, the man still has slight sensory disturbances in the fingers of the left hand and left-sided homonymous hemianopsia. He is now working again at his old profession (managing director) and the projectile is still lodged in the right temporal lobe. 4. But it crosses the midline!But it crosses the midline! 5. Clinical QuestionsClinical Questions In patients with penetrating brain injuries, are any GSW that cross midline of the cranium fatal? Are bihemispheric lesions survivable? 6. Mortality in penetrating brain injuriesMortality in penetrating brain injuries Mortality rate in penetrating brain injuries has been show to range from 55% to 93% so penetrating brain injuries have a high mortality rate. The majority of deaths occur in the first 3 hours and many patients die before arriving at the hospital Of patients that make it to the hospital 80-85% die within 48 hours 7. Civilian vs. Military injuriesCivilian vs. Military injuries Differences in mechanism of injury: predominantly gunshot wounds vs. low velocity shrapnel Civilian injuries have much higher mortality rates Suicide makes up a significant portion of civilian injuries and is correlated with higher mortality rates 8. Clinical findings associated with increasedClinical findings associated with increased mortalitymortality GCS