title: Meningitis following gunshot wound of the neck.
abstract: It is generally assumed that a missile fired from a gun is subjected to sufficient heat to render it sterilized. For this reason, retained bullets are not usually considered a source of infection. The infectious complications associated with gunshot wounds are typically attributed to perforation of a hollow viscus with leakage of gastrointestinal contents causing peritonitis or intra-abdominal abscess. There are several reports of bacterial meningitis involving the spinal cord in gunshot wounds that perforate the intestine prior to involving the thoracic or lumbar vertebral column; however, there are no published reports of cerebral meningitis resulting from a retained projectile in the spinal canal in which there was no injury to the gastrointestinal tract. This manuscript describes a woman who died as a result of unsuspected acute bacterial meningitis which developed secondary to a gunshot wound of the neck. The projectile fractured the first thoracic vertebra, lacerated the dura and contused the spinal cord at the C7-T1 junction. Meningitis developed at the C7-T1 level and ascended along the cervical spinal cord to the brain. The infection caused acute neurologic deterioration and death four days following the initial injury.
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL 33602, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Spitz
authors.forename: Abderrahman
authors.initials: A
authors.lastname: Ouban
mesh_terms: D000328:Adult; D001926:Brain Death; D005260:Female; D006801:Humans; D016920:Meningitis, Bacterial / Q000209:etiology* / Q000473:pathology; D013122:Spinal Diseases / Q000382:microbiology* / Q000473:pathology; D013203:Staphylococcal Infections / Q000209:etiology* / Q000473:pathology; D014948:Wounds, Gunshot / Q000150:complications* / Q000473:pathology