Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 370-371
Birdshots in brain


1 Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin, Turkey
2 Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
3 Department of Pediatric Neurology, Mersin University Faculty of Medicine, Mersin, Turkey

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Date of Web Publication15-Oct-2012
 

How to cite this article:
Arslankoylu AE, Ozgur A, Komur M. Birdshots in brain. J Emerg Trauma Shock 2012;5:370-1

How to cite this URL:
Arslankoylu AE, Ozgur A, Komur M. Birdshots in brain. J Emerg Trauma Shock [serial online] 2012 [cited 2020 Apr 8];5:370-1. Available from: http://www.onlinejets.org/text.asp?2012/5/4/370/102420


Sir,

Cranial traumas from birdshot wounds are serious and life-threatining injuries. Although penetrating brain injury (PBI) is less frequent than closed head trauma, it carries a worse prognosis. [1] Computerized tomography (CT) scan is essential in the emergency setting for initial evaluation of traumatic bone and parenchymatous injuries to determine the indication of neurosurgery and for appropriate medical management. However, CT is recommended as the neuroradiologic modality of choice for the PBI patients. [1] The most significant problem with CT in bridshot wounds is metallic streak artifact. [2] A 2-year-old boy was admitted to the pediatric intensive care unit for eye and brain injury. He had been wounded by birdshot. Cranial CT showed multiple hyperdense birdshots with streak artifacts within the posterior fossa and the occipital lobe [Figure 1]a and b. The birdshots located in orbita bones and different regions of the brain were evaluated as inoperable by neurosurgeons. In patients with gunshot wound in brain, the length of bullet track, the location, and the number of ricochets have a direct correlation with prognosis. [2] Also, intraventricular hemorrhage and bi- or multilobar injury predict poor prognosis. [3] Our patient had long bullet tracks (from orbita to occiput) without intraparenchymal and intraventricular hemorrhage.
Figure 1: Axial consecutive CT images show multiple hyperdense birdshots with streak artifacts within the posterior fossa (a) and the occipital lobe (b). No prominent intraparenchymal hemorrhage is seen. Note the small amount of subdural effusion over the left frontal lobe

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Although birdshot injuries in brain are life-threatining traumas, our patient was discharged without any neurological deficiency despite many number of the birdshots and long bullet tracks in the brain. The prognosis of the patients with birdshot injury in brain with long bullet tracks may be good if there is no intraparenchymal or intraventricular hemorrhage.

 
   References Top

1.Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emerg Trauma Shock 2011;4:395-402.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Offiah C, Twigg S. Imaging assessment of penetrating craniocerebral and spinal trauma. Clin Radiol 2009;64:1146-57.  Back to cited text no. 2
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3.Hofbauer M, Kdolsky R, Figl M, Grünauer J, Aldrian S, Ostermann RC, et al. Predictive factors influencing the outcome after gunshot injuries to the head- a retrospective cohort study. J Trauma 2010;69:770-5.  Back to cited text no. 3
    

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Correspondence Address:
Ali Ertug Arslankoylu
Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.102420

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