title: A tangential gunshot wound to the head: case report and review of the literature.
abstract: BACKGROUND
  Patients with tangential gunshot wounds (TGSWs) commonly present with a good Glasgow Coma Scale score and without a history of loss of consciousness. Typically, the bullet does not breach the skull, however, there is a considerable force directed into the brain, and these patients are best treated as sustaining a moderate-to-severe blunt head injury. These patients require observation and repeat imaging. Physicians should be aware of this entity as these patients can deteriorate in a delayed fashion.
  
  
  OBJECTIVE
  The authors present a case of a TGSW to the head in a neurologically intact patient. The initial post-injury computed tomography (CT) scan showed a very small subdural hematoma (SDH) with no overlying fracture of the skull. A delayed CT scan performed 4 h after arrival to the Emergency Department and 6 h after injury demonstrated an increase in size of the SDH, new traumatic subarachnoid hemorrhage, and bilateral cerebral contusions. Clinically, the patient showed worsening of her neurological examination. She underwent aggressive non-surgical treatment for increased intracranial pressure with almost complete recovery.
  
  
  CONCLUSIONS
  Although patients with TGSWs are typically in good condition upon presentation, these injuries are not always trivial, and these patients should have, at minimum, a non-contrast brain CT scan to evaluate underlying damage to the brain and skull. In addition, a delayed CT scan and close observation on a neurosurgical service are indicated.
authors.affiliation: Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: Hamad Issam
authors.initials: HI
authors.lastname: Farhat
authors.forename: Brian
authors.initials: B
authors.lastname: Hood
authors.forename: M Ross
authors.initials: MR
authors.lastname: Bullock
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005260:Female; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D009483:Neuropsychological Tests; D020206:Subarachnoid Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult