Abstract
BACKGROUNDMilitary neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy.OBSERVATIONSAn infant suffered a massive, acute subdural hemorrhage from a contralateral tangential gunshot wound that did not facture the skull.LESSONSSimilar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head.
Highlights
Military neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury
We report here a case, unique in the literature so far as we can tell, that illustrates the response of the infant head to a tangential gunshot wound, and we place it in the context of the history of wartime neurosurgery
Historical Background From the time of the First World War onward, military neurosurgeons have viewed tangential gunshot wounds of the head with suspicion. They have recognized that the focal, concussive force of a tangential projectile could cause intracranial mischief in the absence of calvarial penetration or even fracture
Summary
Military neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy. LESSONS Similar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head. Case series of cranial gunshot injuries in childhood are few, and few distinctive wounding patterns or clinical management considerations have been defined by these publications.[8–12]. Estimations of trends in the incidence of pediatric firearm injuries vary based on data sources, epochs of study, and intentionality, but firearm injuries remain a clinical challenge for pediatric trauma care.[2–5] Unintentional injuries predominate in early childhood, as expected, but the incidence may be falling among younger White children, unintentional firearm injuries appear to be increasing in frequency among younger Black children.[4,6,7] Case series of cranial gunshot injuries in childhood are few, and few distinctive wounding patterns or clinical management considerations have been defined by these publications.[8–12] We report here a case, unique in the literature so far as we can tell, that illustrates the response of the infant head to a tangential gunshot wound, and we place it in the context of the history of wartime neurosurgery
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