Cranial Gunshot Wounds

Cranial gunshot wounds are open injuries caused by bullets, primary and secondary wounding shells of explosive devices.

Types of cranial gunshot wounds

  1. Injuries to the soft tissues of the head;
  2. Non-penetrating wounds (they damage soft tissues and bone structures);
  3. Penetrating head wounds (soft tissues, bone structures of the skull and brain are damaged).

Complaints of patients with cranial gunshot wounds

  • Headache;
  • Dizziness;
  • Nausea;
  • Vomiting (often repeated);
  • Amnesia (memory impairment);
  • The presence of damage to the soft tissues of the head;
  • Hearing impairment;
  • Flushing of the face.

Complaints depend on the type of weapon used, as well as on the localization and prevalence of the area of damage, the type of wound canal and the accompanying intracranial injuries.

Clinical features

  1. General cerebral symptoms (headache, dizziness, nausea, vomiting, impaired consciousness);
  2. Stem symptoms (floating eye movements, paresis (weakness in the limbs), bilateral miosis or mydriasis (dilation or narrowing of the pupils), strabismus, impaired swallowing, impaired vital functions (breathing, cardiac activity);
  3. Focal symptoms depend on the site of the bruise (pupillary and oculomotor disorders, movement disorders (weakness in the limbs, lack of movement in the limbs), sensory disorders, speech disorders, etc.);
  4. Violations of vital functions (bradycardia or tachycardia (increased or decreased heart rate), increased blood pressure, rapid breathing);
  5. Vegetative symptoms (acrocyanosis (cyanosis of the fingertips, nose), hyperhidrosis (sweating) – especially of the palms, “capillary play” (throws it hot and cold), increased temperature, blood pressure instability, pulse variability – bradycardia, which is replaced by tachycardia, tremor (tremor), etc.

Diagnosis

  • X-ray of the skull;
  • Puncture of the subarachnoid space with taking the cerebrospinal fluid for analysis;
  • CT (computed tomography) and MRI (magnetic resonance imaging) of the brain are leading diagnostic methods.

X-ray of the skull allows us to examine the state of the bones of the skull, the localization of the weapon that injured, as well as the number of foreign metal bodies, mainly to differentiate gunshot wounds of the head from other types of head injuries (non-penetrating soft tissue damage).

CT scan makes it possible to examine in detail the state of the brain and skull bones, to identify hematomas of any localization, to assess the degree of compression and displacement of brain structures, to clarify the number and localization of injuring elements, to distinguish gunshot-explosive head injuries from other types of head injuries (injuries soft tissue, non-penetrating), conduct the dynamic observation.

Surgical treatment of cranial gunshot wounds

All penetrating gunshot wounds to the head are subject to early (up to 6 hours) primary surgical treatment. Primary surgical treatment for gunshot-explosive injuries of the head is carried out in neurosurgical departments.

Surgical treatment for cranial gunshot wounds is carried out under general anesthesia. In the case of wounds from a hunting weapon with the presence of a large number of wounding elements, a ridged flap of skin is folded back to release the operating field. When the soft tissues of the head are injured from a gas weapon, the edges of the wound are treated with alkaline antiseptics in order to prevent the development of necrosis in the postoperative period. In case of through wounds, the primary surgical treatment starts from the inlet and ends with the outlet. With a large number of closely spaced perforated fractures, emergency craniotomy is indicated – the surgeon removes a heavily damaged area of the bone, bone fragments, hematoma, as well as foreign objects trapped in the wound. The perforating gunshot wound is washed with antiseptic solutions, the bleeding is stopped. Drainage tubes are installed.