About Cranial GunShot Wounds

General Information

• Since the late 1950s, firearm deaths have increased dramatically in the United States. In 1988, guns were responsible for 34,000 deaths in this country, making them the eighth leading cause of death. Suicide accounted for 53 percent of the fatalities and homicides 40 percent. Accidental shootings and those with undetermined causes made up the remainder. For every firearm-related death, an additional seven people sustain nonfatal gunshot wounds.
• Gunshot wounds to the head, the most lethal of all firearm injuries, rank among the leading causes of head injury in many United States cities. They carry a fatality rate greater than 90 percent, and at least two-thirds of the victims die before reaching a hospital.
• Because of the high mortality rate, cranial gunshot wounds account for only about 10 percent of traumatic brain injury patients who survive.

Diagnosis

• If a patient's blood pressure and oxygen level can be maintained upon arrival at the hospital, an urgent computed tomography (CT) scan of the brain is obtained.

Treatment

• Virtually all cranial gunshot victims are aggressively resuscitated upon initial arrival at the hospital.
• The decision to proceed with surgery to manage the wound is based on three factors:
  • The level of consciousness as determined by the Glasgow Coma Scale (GCS)
  • The degree of brainstem neurological function
  • The findings on the CT scan
• Death is virtually certain among comatose patients with minimal evidence of brainstem function and no evidence of an intracranial hematoma.
  • In such patients, aggressive treatment is rarely pursued because of the futility of the situation.
  • If, however, the CT scan identifies a hematoma, a craniotomy to open a section of skull and surgically remove the clot is generally warranted, and some of these patients will make a satisfactory recovery.

Outcome

• Recovery after brain injury varies widely.
• The predictors of poor brain function outcome or death after a gunshot wound to the head include the initial GCS score, older age, presence of low blood pressure or inadequate blood oxygen shortly after injury, and dilated non-reactive pupils.
• The bullet trajectory through the brain carries major significance. Bullets that cut through the brainstem, multiple lobes of the brain, or the chambers where spinal fluid is located are particularly lethal.
• Many initial survivors develop uncontrollable pressure on the brain and subsequently die.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide