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IP Indian Journal of Neurosciences


Prognostic factors and management of civilian craniocerebral gunshot injuries; an institutional experience


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Research Article

Author Details : Zafer Kamal Anjum, Raman Mohan Sharma*, M Tabish Khan, M F Huda, Obaid Siddique

Volume : 5, Issue : 4, Year : 2019

Article Page : 236-240


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Abstract

Introduction: Surgeons face unique challenge in the management & prognosis related issues with
intracranial gunshot injuries. These injuries are more commonly seen in military conflict zone. With easy
availaibility of weapon and increase in the conflict between civilian and paramilitiary forces, clinician are
facing more numbers of civilian gunshot injuries. In India the presentation and prognosis of gunshot injuries
is different as many of these gunshot injuries are by country made weapons. Country made weapons have
low velocity and caliber; henceforth the outcome and the management issues are different. We present our
experience with 23 patients who sustained intracranial gunshot injuries, and identify the factors determining
the outcome and management
Material and methods: From March 2016 to September 2019 data was collected from 23 cases who
were treated for intracranial gunshot injuries in Department of Neurosurgery at J. N. Medical College,
Aligarh. History, type of weapon used, clinical condition and radiological findings were noted. Outcome
was assessed by Glasgow’s Outcome scale.
Results: Overall mortality was 26.08% (6/23). Of the 4 patients in GCS (3-7) group there was 100%
mortality. Of the 5 patients in GCS group (8-12) mortality was 2 and one patient in persistent vegetative
stage. All patients survived in GCS group (13-15). 5 patients underwent surgery; there was one mortality
in the surgical group. Better outcome was noted in single lobe involvement and trajectory involving
supratentorial noneloquent areas.
Conclusion: Early aggressive resuscitative measures may help in better management. GCS at presentation
is the most important factor affecting outcome. CT scan offers to be an important predictor of prognosis and
also help in planning the management. Suicidal wound, hypotension and midline shift has poor prognosis.
We don’t recommend aggressive exploration of the bullet tract & pellet removal for every patient.

Keywords: Intracerebral gunshot, Cranial gunshot, Civilian, Firearm injuries

Doi : 10.18231/j.ijn.2019.039

How to cite : Anjum Z K, Sharma R M, Khan M T , Huda M F , Siddique O , Prognostic factors and management of civilian craniocerebral gunshot injuries; an institutional experience. IP Indian J Neurosci 2019;5(4):236-240

Copyright © 2019 by author(s) and IP Indian J Neurosci. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC-BY-NC 4.0) (creativecommons.org)