718 Cryptogenic Stroke in a Patient with Firearm Injury - a Diagnostic Dilemma

Abstract

Abstract Introduction Neurological deficit associated with firearm injury outside the head and neck region is a rare phenomenon. Multiple explanations, including pellet embolization, patent foramen ovale and carotid intimal tear, have been suggested. Case Report We present a case of an otherwise healthy 21-year-old male, who was received in the emergency with a firearm injury, unstable vitals, and GCS 14/15. Bullet entry wound was on the back of the chest, 3 cm medial to the spine of left scapula, with no exit wound, but bullet palpable superior to the medial 1/3rd of right clavicle. CT and X-ray imaging confirmed surgical emphysema and left sided haemopneumothorax. Two release incisions were given superior to the medial 1/3rd of both clavicles. Bullet was found below the right release incision and was retrieved. Chest tube was inserted bilaterally, and the patient was placed on mechanical ventilation. On the 5th day, upon resolution of emphysema and haemopneumothorax, the patient was extubated, and the chest tubes were removed. However, examination findings revealed left facial and abducens palsy along with left circumduction gait. MRI brain showed ischaemic changes in the right frontoparietal region. Carotid angiography and echocardiography were normal. Patient was then managed by neurology and neurosurgery. Conclusion In cases of firearm injury the physician should always look for neurological deficits, irrespective of the firearm injury pathway through the body. Stroke should be a concern in such cases even if the patient is otherwise healthy and young.