Volume 36, Issue 4 (12-2025)
Studies in Medical Sciences 2025, 36(4): 38-42 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Khanoghlan A, gholipour P. Transient Survival After a Self-Inflicted Trans-Temporal Gunshot Traversing the Midbrain and Diencephalon: A Case Report. Studies in Medical Sciences 2025; 36 (4) :38-42
URL: http://umj.umsu.ac.ir/article-1-6505-en.html
URL: http://umj.umsu.ac.ir/article-1-6505-en.html
urmia medical university , gholipour.p@umsu.ac.ir
Abstract: (15 Views)
Background: Self-inflicted gunshot wounds to the head are uncommon in adolescents and are almost always fatal because of the high kinetic energy and destruction of vital brain structures.
Case Presentation: We report a 17-year-old male who sustained a self-inflicted trans-temporal gunshot wound. Computed tomography revealed a right-to-left bullet trajectory traversing the midbrain and diencephalon with extensive bilateral temporal destruction. Despite immediate resuscitation, mechanical ventilation, and osmotic therapy, the patient remained comatose (GCS 5T) and developed progressive brainstem dysfunction. He survived for 15 hours after injury before cardiac arrest occurred.
Conclusion: Survival after a sharp gunshot that crosses the mesencephalon–diencephalon junction is particularly rare. This case determines that transient survival can occur when the bullet follows an oblique trajectory that spares key autonomic centers, while secondary injury mechanisms cause delayed worsening .
Case Presentation: We report a 17-year-old male who sustained a self-inflicted trans-temporal gunshot wound. Computed tomography revealed a right-to-left bullet trajectory traversing the midbrain and diencephalon with extensive bilateral temporal destruction. Despite immediate resuscitation, mechanical ventilation, and osmotic therapy, the patient remained comatose (GCS 5T) and developed progressive brainstem dysfunction. He survived for 15 hours after injury before cardiac arrest occurred.
Conclusion: Survival after a sharp gunshot that crosses the mesencephalon–diencephalon junction is particularly rare. This case determines that transient survival can occur when the bullet follows an oblique trajectory that spares key autonomic centers, while secondary injury mechanisms cause delayed worsening .
Type of Study: case report |
Subject:
جراحی مغز و اعصاب
References
1. Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, et al. Firearm-related injuries and deaths in children and youth. Pediatrics. 2022;150(6):e2022060071. [DOI:10.1542/peds.2022-060071] [PMID]
2. Murray L. Craniocerebral nail gun injuries: a definitive review of the literature. Brain injury. 2021;35(2):164-72. [DOI:10.1080/02699052.2020.1867767] [PMID]
3. Dengler B, Bell R. The Development of Best Practice Penetrating TBI Guidelines for Military and Civilian Patients. 2022. [GOOGLE SCHOLAR]
4. Kerkhoff W, Glardon M, Schyma C, Alberink I, Oostra R, Riva F. The influence of impact velocity on bullet trajectory deflection through ballistic gelatine. Forensic science international. 2023;346:111675. [DOI:10.1016/j.forsciint.2023.111675] [PMID]
5. Shah VA, Thompson RE, Yenokyan G, Acosta JN, Avadhani R, Dlugash R, et al. One-year outcome trajectories and factors associated with functional recovery among survivors of intracerebral and intraventricular hemorrhage with initial severe disability. JAMA neurology. 2022;79(9):856-68. [DOI:10.1001/jamaneurol.2022.1991] [PMID]
6. Levy ML, Masri LS, Levy KM, Johnson FL, Martin-Thomson E, Couldwell WT, et al. Penetrating craniocerebral injury resultant from gunshot wounds: gang-related injury in children and adolescents. Neurosurgery. 1993;33(6):1018-25.
https://doi.org/10.1097/00006123-199312000-00009 [DOI:10.1227/00006123-199312000-00009] [PMID]
7. Beghi E, Helbok R, Moro E, Sampson J, Altamirano V, Mainali S, et al. A nationwide analysis of gunshot wounds of the head and neck: morbidity, mortality, and cost. JAMA network open. 2021;4(5):e2112131-e. [GOOGLE SCHOLAR]
8. Khan MB, Kumar R, Irfan FB, Irfan AB, Bari ME. Civilian craniocerebral gunshot injuries in a developing country: presentation, injury characteristics, prognostic indicators, and complications. World neurosurgery. 2014;82(1-2):14-9. [DOI:10.1016/j.wneu.2013.01.026] [PMID]
9. Dawoud FM, Feldman MJ, Yengo-Kahn AM, Roth SG, Wolfson DI, Ahluwalia R, et al. Traumatic cerebrovascular injuries associated with gunshot wounds to the head: a single-institution ten-year experience. World neurosurgery. 2021;146:e1031-e44. [DOI:10.1016/j.wneu.2020.11.078] [PMID]
10. Temesgen M, Tadele A, Equar S, Worku M, Yusuf A, Bergene E, et al. Outcome and Prognostic Factors of Surgically Treated Patients with Civilian Gunshot Wound to the Head in an Ethiopian Trauma Center. WFNS Journal. 2025;2(01):e14-e20. [DOI:10.1055/a-2554-1935]
11. Reddy HR, Bay C, Layne SA, Williams M, Fossett D. A case of complete recovery from a transcranial bi-hemispheric civilian gunshot wound: a case report. J Case Rep Images Surg. 2021;7:100092Z12HR2021. [GOOGLE SCHOLAR]
12. Aarabi B, Tofighi B, Kufera JA, Hadley J, Ahn ES, Cooper C, et al. Predictors of outcome in civilian gunshot wounds to the head. Journal of neurosurgery. 2014;120(5):1138-46. [DOI:10.3171/2014.1.JNS131869] [PMID]
13. Leestma J, Kirkpatrick JB. Gunshot, penetrating and blast related injuries to the nervous system. Forensic neuropathology, 3rd edn CRC Press, Taylor and Francis Group, Boca Raton. 2014:655-97. [URL]
14. Fowler D. Projectile and Explosive Injuries of the Central Nervous System. Essential forensic neuropathology Philadelphia: Lippincot Williams & Wilkins. 2010:98-104. [URL]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
