en جراحی مغز و اعصاب جراحی مغز و اعصاب گزارش مورد case report <b>&nbsp;</b> <b>&nbsp;</b><span style="font-size:11pt"><span style="line-height:107%"><span calibri="" style="font-family:"><b>Background</b>: 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.<br> <b>Case Presentation</b>: 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.<br> <b>Conclusion: </b>Survival after a sharp gunshot that crosses the mesencephalon&ndash;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 .</span></span></span><br> <br> <br> &nbsp; Diencephalon, Gunshot wounds, Midbrain, Suicide, Traumatic brain injury 38 42 http://umj.umsu.ac.ir/browse.php?a_code=A-10-5756-4&slc_lang=en&sid=1 arefeh Khanoghlan khanoghlan.a@umsu.ac.ir 3700319475328460038745 0009-0007-3260-6372 No urmia medical university peyman gholipour gholipour.p@umsu.ac.ir 3700319475328460038746 3700319475328460038746 Yes urmia medical university