Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the hea...Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.展开更多
Calcified chronic subdural hematoma(CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas(CSDHs). The clinical features of CCSDH are very similar to those of noncalcifie...Calcified chronic subdural hematoma(CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas(CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache,decreased alertness,weakness,numbness,gait disturbance,seizures,memory impairment,confusion,and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report,we present the case of a patient with CCSDH who developed severe cerebral edema following its removal,necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests,and no signs of brain herniation or epilepsy was found the following day after surgery,the patient's family refused all treatment and a post-operative brain computed tomography(CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough(NPPB) may cause severe cerebral edema following the total removal of a CCSDH.展开更多
文摘Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.
文摘Calcified chronic subdural hematoma(CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas(CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache,decreased alertness,weakness,numbness,gait disturbance,seizures,memory impairment,confusion,and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report,we present the case of a patient with CCSDH who developed severe cerebral edema following its removal,necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests,and no signs of brain herniation or epilepsy was found the following day after surgery,the patient's family refused all treatment and a post-operative brain computed tomography(CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough(NPPB) may cause severe cerebral edema following the total removal of a CCSDH.
