Civilian gunshot wounds of the brain

Kirkpatrick, JB; Maio, Vittorio Di

doi:10.3171/jns.1978.49.2.0185

Cited by 78 publications

(25 citation statements)

References 29 publications

(3 reference statements)

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“…Impact against falx or tentorium can possibly have similar effects (Freytag 1963). Consequently, cortical contusions are reported to be most frequently located in the cerebellar tonsils and at the base of the frontal, temporal and occipital lobes (Freytag 1963;Henn and Liebhardt 1969;Kirkpatrick and DiMaio 1978). Not infrequently, skull fractures are found at corresponding sites (Henri and Liebhardt 1969).…”

Section: Special Wound Ballistics Of the Headmentioning

confidence: 99%

“…Because of the inelastic quality and the high water content of brain tissue, it is per se very vulnerable to cavitation and stretch mechanism (Fackler 1991). The penetration of the skull can imply the generation of secondary missiles in the form of bone or bullet fragments (Clemedson et al 1973;Kirkpatrick and DiMaio 1978;Allen et al 1983;Finnie 1993) and a tendency towards early tumling or deformation of the bullet. Kirkpatrick and DiMaio (1978), for example, were able to demonstrate intracerebral bone chips solely by digital palpation of the brain in 16 out of 42 cases of civilian gunshot wounds to the brain.…”

Section: Special Wound Ballistics Of the Headmentioning

confidence: 99%

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Penetrating gunshots to the head and lack of immediate incapacitation

Karger

1995

Int J Leg Med

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There are two distinct mechanisms of ballistic injury. Crushing of tissue resulting in a permanent tract is the primary factor in wounding of most tissues and most body regions. Temporary cavitation causes radial tissue displacement and subsequent shearing, compression and especially stretching of tissue analogous to blunt trauma. In contrast to the effect in elastic tissue, temporary cavitation can contribute substantially to wounding of inelastic tissue, such as the brain. This is the case in penetrating gunshot wounds to the head. Additionally, the penetration of the bony cranium can produce secondary missiles in the form of bone or bullet fragments and a tendency of the bullet to deformation and early yaw. Most important, wounding resulting from temporary cavitation is greatly augmented by the confined space provided by the unyielding walls of the skull. Bone contact and enhanced effects of temporary cavitation result in an enlarged zone of disintegrated tissue and in high intracranial peak pressures. Morphological signs of powerful intracranial pressure effects are cortical contusion zones, indirect skull fractures and perivascular haemorrhages remote from the tract. Depending on ballistic and anatomical parameters, the intracranial effect varies from slightly more severe injury than in isolated soft tissue to an "explosive" type of injury with comminuted fractures of the skull and laceration of the brain. Incapacitation is the physiologically based inability to perform complex and longer lasting movements independent of consciousness or intention. Immediate incapacitation is possible following cranio-cerebral gunshot wounds or wounds that disrupt the upper cervical spinal cord only. Rapid incapacitation can be produced by massive bleeding from major vessels or the heart. Immediate incapacitation is the result of primary intracranial effects of the bullet. A mechanism similar to commotion cerebri applied extracranially does not exist in cases of penetrating gunshot wounds to the head.

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Section: Special Wound Ballistics Of the Headmentioning

confidence: 99%

Section: Special Wound Ballistics Of the Headmentioning

confidence: 99%

Penetrating gunshots to the head and lack of immediate incapacitation

Karger

1995

Int J Leg Med

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“…B. Karger: Gunshot wounds and incapacitation. II tion by macroscopic observation or digital palpation (Kirkpatrick and DiMaio 1978). But with regard to wound ballistics, prerequisites for the generation of secondary missiles are fracture zones at the impact site or fast or suitably constructed projectiles.…”

Section: Wounded Brain Areasmentioning

confidence: 99%

Penetrating gunshots to the head and lack of immediate incapacitation II. Review of case reports

Karger

1995

Int J Leg Med

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Because of the enhanced intracranial tissue disruption (see companion paper) and the functional significance of the central nervous system, penetrating gunshot wounds of the head commonly result in immediate incapacitation. However, in the last century numerous publications reported sustained capability to act following penetrating gunshot wounds of the head. These are reviewed. A large number of case reports had to be excluded from re-examination because of doubtful capability to act or lack of morphological documentation. There remained 53 case reports from 42 sources for systematic analysis. Favourable conditions for sustained capability to act are present in cases where the additional wounding resulting from the special wound ballistic qualities of the head (see companion paper) are minimized. Thus, more than 70% of the guns used fired slow and lightweight bullets: 6.35 mm Browning, .22 rimfire or extremely ineffective projectiles (ancient, inappropriate or selfmade). A centre-fire rifle or a shotgun from close range were never employed in cases involving intracerebral tracts. A coincidence of several lucky circumstances made sustained capability to act possible in two cases of military centrefire rifle bullets passing longitudinally between the frontal lobes without direct contact with brain tissue. Only two large handguns resulting in intracerebral wounding were used: one firing a .38 special bullet, which solely wounded the base of the right temporal lobe and one firing a .45 lead bullet, which seriously injured the left frontal lobe but whose trajectory was limited to the anterior fossa of the skull. Of the trajectories, 28% were outside the neurocranium. At least 70% of the craniocerebral tracts passed above the anterior fossa of the skull, wounding the frontal parts of the brain. Apart from a neurophysiological approach, this preference can be explained by the fact that the base of the anterior cranial fossa and the sella turcica area serve as a bony barrier protecting the parts of the brain located in its "shadow"' relative to the trajectory against cavitational tissue displacement and associated overpressures. This is particularly true of the brain stem. Intracerebral trajectories not located above the anterior fossa were caused by slow and lightweight bullets preferring one temporal lobe. Additionally, one parietal and one occipital lobe were each injured once by a very ineffective projectile and by a 7.65-mm bullet reduced in velocity. Not a single case of injury to the brain stem, the diencephalon, the cerebellum or major paths of motor conduction and only one grazing shot of the anterior parts of the nucleus caudatus (basal ganglia) were described. Morphological signs of high intracranial pressure peaks (cortical contusion zones, indirect skull fractures, perivascular haemorrhages) and secondary missiles were poorly documented. It is suggested that these findings are at least very rare and not obvious in cases of sustained capability to act.

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“…Extensive literature has been devoted to the management of firearm injuries (7,11,41,53). Emergency medical services systems, originally developed to reduce motor vehicle mortality (8), have also been used with great effect to treat and transport people with firearm-related trauma.…”

Section: Acute Care and Rehabilitationmentioning

confidence: 99%