Current Concepts in Penetrating and Blast Injury to the Central Nervous System

Abstract

AimTo review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing.MethodsA review of the current literature was performed.ResultsOf patients with craniocerebral GSW, 66–90 % die before reaching hospital. Of those who are admitted to hospital, up to 51 % survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13–17 % of all gunshot injuries.ConclusionsUrgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4–5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

“…1,2 In addition, what literature there is on the topic has mostly emanated from the military and may not be directly relevant to the civilian setting. [3][4][5][6][7][8] South Africa is a low to middle income country with significant discrepancies in wealth and access to health care and with a persistently high rate of trauma, with a major component of this being due to interpersonal violence. 2,7,8 This means that a significant proportion of TBI in South Africa is secondary to penetrating trauma, however this experience has not been documented in great detail.…”

Safety of Neural Stem Cell Therapy for Traumatic Brain Injury

“…Despite increasing incidence, timely neurosurgical intervention aided with improved neuroimaging and advances in acute trauma management have lowered the firearm fatality rate {Joseph, 2014 #42;Lin, 2012 #164;Young, 2008 #56}. Thus, among the estimated 5.3 million people living in the US with traumatic brain injury (TBI)-related disability, the proportion of gun-shot wound survivors has been rising steadily [3][4][5][6][7][8]. Among head injuries, penetrating injuries (PTBI) are associated with the worst outcomes [9,10], and no effective restorative treatment beyond physical therapy is currently available to mitigate post-TBI disability [9][10][11].…”

One Step at a Time, Stem Cell Therapy for Traumatic Brain Injury Needs Two More Breakthroughs

“…[4][5][6] Thus, among the estimated 5.3 million people living in the US with traumatic brain injury (TBI)-related disability, the proportion of gun-shot wound survivors has been rising steadily. 3,[7][8][9][10][11] Among head injuries, penetrating injuries (PTBI) are associated with the worst outcomes. 12,13 and no effective restorative treatment beyond physical therapy is currently available to mitigate post-TBI disability.…”