A Patient Presenting with Paraplegia Secondary to Cranial Gunshot Injury: A Case Report

Abstract

Cranial gunshot injuries (CGI) have an important place in head injuries and progress with significant rates of mortality and morbidity. Several studies have reported mortality rates of 51-84%, and most of the cases die at the time of the incident or short time after the event. The parenchymal damage, hemorrhage, edema, and intraventricular hemorrhage caused by the missile, hernia, bihemisphericality of the damage, neurological and general condition of the patient, Glasgow Coma Scale (GCS), and treatment approach have been reported as the most important factors. A 19 year- old- man with cranial gunshot injuries was found alone at his home. The first physical examination findings of this unconscious male patient in the emergency department were as follows: GCS 9 pts, movement of upper extremity induced by painful stimuli, and paraplegic lower extremities. Computed tomographic (CT) scan showed bullet entry hole in the right parieto-occipital region, bone fragments and hematoma in the parenchyma, and in the left parieto-occipital region, bullet exit hole, hematoma and subarachnoidal hemorrhage (SAH). The patient had normal biochemistry values. There was no coagulopathy and bleeding diathesis. Anti-edematous and broad-spectrum antibiotic therapy were initiated, and emergency surgery was performed. Nonfunctioning necrotic brain tissue was debrided during surgery, hematoma was evacuated and accessible bone fragments were removed. Craniectomized was implanted in the lateral side of the right leg. Control CT showed disappearance of edema, and resorption of hematoma was observed.. paraplegia due to Spinal magnetic resonance imaging (MRI) performed with the indication of paraplegia did not reveal any pathology. The patient’s left lower extremity on final control neurologic examination any additional neurological deficit, excepting 4+/5 loss of muscle strength was not detected. Many studies have been made on CGI, however rarely the patient with paraplegia have been reported secondary cranial gunshot injuries. CGI is an important neurosurgical problem with higher rates of mortality and morbidity. There is no clear-cut information about the management of these patients. We thought that if appropriate, and effective medical approach is implemented starting from the time of the incident, and multidisciplinary, and timely intervention is achieved, then mortality, and morbidity rates will decrease. We believe that spinal MR imaging needs to be done in CGI patients presenting with paraplegia.