Penetrating brain injury from an accidental air gun shot: a case report

Sri Maliawan; Steven Awyono; Eufrata Silvestris Junus; Bagus Dwiki Arya Dharma; Tjokorda Gde Bagus Mahadewa

doi:10.15562/bmj.v12i2.4571

Penetrating brain injury from an accidental air gun shot: a case report

Sri Maliawan ,

Steven Awyono ,

Eufrata Silvestris Junus ,

Bagus Dwiki Arya Dharma ,

Tjokorda Gde Bagus Mahadewa ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i2.4571 |
Published: 2023-07-20

Abstract

Background: Air gun shot injury is a gunshot wound from a pistol or rifle that fires a bullet. The most common part of the body that penetrates in air gunshot injuries is the head, especially the orbit. The majority of fatal cases have been reported to enter that location and commonly involve children and adults. This report presents an interesting point of air gunshot injuries with brain damage surgical management.

Case Description: A 6-year-old boy got referred from other hospitals and came unconscious after being shot in the head by an air gun about eight hours before being admitted to the hospital with a range of about two meters. The patient was said to have accidentally been shot from the front of the head. The patient had a history of vomiting without a history of consciousness and seizure. On the primary survey, the airway, breathing, and circulation were clear, with a Glasgow Coma Scale (GCS) of 13. Based on the clinical examination and the result of the head CT scan, the patient was diagnosed with penetrating brain injury at the left parietal region, with multiple fragmented objects, intracerebral hemorrhage, and intraventricular hemorrhage. We then perform urgent surgery to debride and extract the bullet. There was no surgical morbidity in this patient, who was allowed to go home.

Conclusion: Penetrating brain injuries resulting from air gunshot wounds require exceptional management. Early surgery to debride the wound with consideration of bullet extraction is needed to prevent further complications and for a better outcome for the patient.

References

Laraque D. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Injury risk of nonpowder guns. Pediatrics. 2004;114:1357–61.
Milroy C, Clark J, Carter N, Rutty G, Rooney N. Air weapon fatalities. J Clin Pathol. 1998;51:525–9.
Tsui C, Tsui K, Tang Y. Ball bearing (BB) gun injuries. J Emerg Med. 2010;17:488–91.
Apelt N, Greenwell C, Tweed J, Notrica D, Maxson R, Garcia N, et al. Air guns: a contemporary review of injuries at six pediatric level I trauma centers. J Surg Res. 2020;248:1–6.
Kiran D, Mittal S. Gunshot (pellets) injury to the maxillofacial complex: a case report. Chinese J Traumatol. 2014;17(3):170–2.
Wijaya A, Ayusta I, Niryana I. Air gun wound: bihemispheric penetrating brain injury in a paediatric patient. BJR Case Rep. 2019;5(2):20180070.
Klopotek B, Weibley R, Chapados R. Air rifles are more than toys: BB gun-related traumatic brain injury. Pediatr Ann. 2014;43(12):494–6.
Miner M, Cabrera J, Ford E. Intracranial penetration due to BB air rifle injuries. Neurosurgery. 1986;19:952–4.
Nguyen M, Annest J, Mercy J, Ryan G, Fingerhut L. Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99. Inj Prev. 2002;8(3):185–91.
Ceylan H, McGowan A, Stringer M. Air weapon injuries: a serious and persistent problem. Arch Dis Child. 2002;86(4):234–5.
Rahmatullah MI, Parenrengi MA, Suryaningtyas W. Unintentional penetrating brain injuries caused by air rifles in teenagers: Two case report. Interdiscip Neurosurg Adv Tech Case Manag. 2021;25:101203.
Bratton SL, Dowd MD, Brogan T V, Hegenbarth MA. Serious and fatal air gun injuries: more than meets the eye. Pediatrics. 1997;100(4):609–12.
Martinez-Lage J, Mesones J, Gilabert A. Air-gun pellet injuries to the head and neck in children. Pediatr Surg Int. 2001;17:657–60.
Van Wyck DW, Grant GA. Penetrating traumatic brain injury: a review of current evaluation and management concepts. J Neurol Neurophysiol. 2015;6(6):1000336.
Syrmos N, Ganau M, De Carlo A, Prisco L, Ganau L, Valadakis V, et al. Dealing with the surgical and medical challenges of penetrating brain injuries. Case Rep Surg. 2013;2013:1–4.
Alvis-Miranda HR, Adie Villafañe R, Rojas A, Alcala-Cerra G, Moscote-Salazar LR. Management of craniocerebral gunshot injuries: a review. Korean J Neurotrauma. 2015;11(2):35.
Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emergencies, Trauma Shock. 2011;4(3):395–402.
Amirjamshidi A, Abbassioun K. Air-gun pellet injuries to the head and neck: what are the mechanisms of injury and optimal steps in management? J Neurosurg Pediatr. 2016;18:507–10.
Gondowardojo YRB, Argie D, Adam A, Ratnasari NLMN. Clinical, radiological features, and surgical management of spontaneous intracerebral hemorrhage patients in East Nusa Tenggara-Indonesia. Bali Med J. 2018;7(2):426-30.

[1] Laraque D. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Injury risk of nonpowder guns. Pediatrics. 2004;114:1357–61.

[2] Milroy C, Clark J, Carter N, Rutty G, Rooney N. Air weapon fatalities. J Clin Pathol. 1998;51:525–9.

[3] Tsui C, Tsui K, Tang Y. Ball bearing (BB) gun injuries. J Emerg Med. 2010;17:488–91.

[4] Apelt N, Greenwell C, Tweed J, Notrica D, Maxson R, Garcia N, et al. Air guns: a contemporary review of injuries at six pediatric level I trauma centers. J Surg Res. 2020;248:1–6.

[5] Kiran D, Mittal S. Gunshot (pellets) injury to the maxillofacial complex: a case report. Chinese J Traumatol. 2014;17(3):170–2.

[6] Wijaya A, Ayusta I, Niryana I. Air gun wound: bihemispheric penetrating brain injury in a paediatric patient. BJR Case Rep. 2019;5(2):20180070.

[7] Klopotek B, Weibley R, Chapados R. Air rifles are more than toys: BB gun-related traumatic brain injury. Pediatr Ann. 2014;43(12):494–6.

[8] Miner M, Cabrera J, Ford E. Intracranial penetration due to BB air rifle injuries. Neurosurgery. 1986;19:952–4.

[9] Nguyen M, Annest J, Mercy J, Ryan G, Fingerhut L. Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99. Inj Prev. 2002;8(3):185–91.

[10] Ceylan H, McGowan A, Stringer M. Air weapon injuries: a serious and persistent problem. Arch Dis Child. 2002;86(4):234–5.

[11] Rahmatullah MI, Parenrengi MA, Suryaningtyas W. Unintentional penetrating brain injuries caused by air rifles in teenagers: Two case report. Interdiscip Neurosurg Adv Tech Case Manag. 2021;25:101203.

[12] Bratton SL, Dowd MD, Brogan T V, Hegenbarth MA. Serious and fatal air gun injuries: more than meets the eye. Pediatrics. 1997;100(4):609–12.

[13] Martinez-Lage J, Mesones J, Gilabert A. Air-gun pellet injuries to the head and neck in children. Pediatr Surg Int. 2001;17:657–60.

[14] Van Wyck DW, Grant GA. Penetrating traumatic brain injury: a review of current evaluation and management concepts. J Neurol Neurophysiol. 2015;6(6):1000336.

[15] Syrmos N, Ganau M, De Carlo A, Prisco L, Ganau L, Valadakis V, et al. Dealing with the surgical and medical challenges of penetrating brain injuries. Case Rep Surg. 2013;2013:1–4.

[16] Alvis-Miranda HR, Adie Villafañe R, Rojas A, Alcala-Cerra G, Moscote-Salazar LR. Management of craniocerebral gunshot injuries: a review. Korean J Neurotrauma. 2015;11(2):35.

[17] Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emergencies, Trauma Shock. 2011;4(3):395–402.

[18] Amirjamshidi A, Abbassioun K. Air-gun pellet injuries to the head and neck: what are the mechanisms of injury and optimal steps in management? J Neurosurg Pediatr. 2016;18:507–10.

[19] Gondowardojo YRB, Argie D, Adam A, Ratnasari NLMN. Clinical, radiological features, and surgical management of spontaneous intracerebral hemorrhage patients in East Nusa Tenggara-Indonesia. Bali Med J. 2018;7(2):426-30.

Penetrating brain injury from an accidental air gun shot: a case report

Abstract

References

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