Loading your page…
Journal of 21 September university for medical and applied sciences
By Noofel Al-Ashhab, Sakhr Alfaqih, Mohamed Shamsaldin and 1 others.
Ward brings these articles into the same app as your cards and questions. One free account for Ward, Suture, Osler and Prognia.
Penetrating craniofacial gunshot wounds (GSWs) are among the most lethal forms of traumatic brain injury (TBI). Civilian survival rates are frequently below 15%, and mortality rates approach 80–98% in patients presenting with a Glasgow Coma Scale (GCS) score ≤5. Although admission GCS is the strongest predictor of outcome, limited cases of meaningful recovery suggest that prognosis should not rely on GCS alone. Case Presentation:A 25-year-old man presented one hour after a self-inflicted point-blank craniofacial gunshot wound. On arrival, he was hypotensive (80/50 mmHg), hypoxic (SpO₂ ~60%), and comatose with GCS 5 (E1V1M3). Examination revealed a large destructive left craniofacial wound with exposed brain tissue, a ruptured left globe, decorticate posturing, and a fixed dilated right pupil. After aggressive resuscitation and stabilization, computed tomography demonstrated extensive comminuted craniofacial fractures, a large left frontal bone defect, and unilateral frontal lobe contusions without ventricular violation or a transhemispheric trajectory. Emergent multidisciplinary surgery included extensive debridement, removal of bone and foreign fragments, hemostasis, duraplasty using fascia lata graft, and staged facial reconstruction. Postoperatively, the patient demonstrated rapid neurological improvement. By postoperative day 7, he was fully conscious, oriented, and neurologically intact except for left monocular blindness. A transient cerebrospinal fluid (CSF) leak resolved with conservative therapy. At 12 months, he exhibited normal speech, intact motor function, and stable cognitive recovery.
Extremely low admission GCS should not automatically preclude aggressive intervention in penetrating brain injury. Injury trajectory, ventricular involvement, rapid correction of secondary insults, and coordinated multidisciplinary management critically influence outcome. Carefully selected patients may achieve meaningful recovery despite traditionally grave prognostic indicators.
Published in Journal of 21 September university for medical and applied sciences. The abstract is shown as published and remains the work of its authors; read the full article at the source.
Prognia lists this article for reference and education. It is not medical advice. Always read the original and follow current guidelines and local protocols before acting on it.
