Tangential gunshot wound to the head

Abstract

Introduction. Tangential gunshot wounds (TGSW) to the head is the high-velocity bullet that does not penetrate the cranium but passes through the tissue adjoining the cranial cavity, creating a “gutter” wound and indirectly causing cerebral injury. This article presents a reporting case of TGSW to the head, discusses the mechanism underlying this traumatic injury and the possible complications resulting from it, and reviews of literature. Case description. A thirteen-year-old schoolboy was admitted to the emergency department (ER) of the neurosurgery teaching hospital in Baghdad, Iraq, with a tangential gunshot to the head of an unknown source during civilian protests in Baghdad. In addition to a seizure attack in the ER, his Glasgow coma (GCS) scale was 13 initially. The computed tomography showed multiple bilateral brain contusions, interhemispheric haemorrhage, partially depressed fracture of the frontal bone midline, and a Paramedian to the left with a significantly depressed skull fracture. Then, an urgent decompressive craniectomy was performed. The postoperative course was uneventful, with rapid improvement in GCS of 15 one hour after surgery. On the six-month follow-up, the patient reported no further attacks of seizure. Conclusion. TGSWs are associated with good GCS and favourable prognosis in most cases unless the patient has been deteriorating or has an associated ICH. Moreover, in our case, the history taking, mechanism of the injury, rapid evolution, and radiological imaging have an essential effect on the outcome.