title: Delayed acute spinal cord injury following intracranial gunshot trauma: case report.
abstract: The authors report the case of a patient who presented with a hoarse voice and left hemiparesis following a gunshot injury with trajectory entering the left scapula, traversing the suboccipital bone, and coming to rest in the right lateral medullary cistern. Following recovery from the hemiparesis, abrupt quadriparesis occurred coincident with fall of the bullet into the anterior spinal canal. The bullet was retrieved following a C-2 and C-3 laminectomy, and postoperative MR imaging confirmed signal change in the cord at the level where the bullet had lodged. The patient then made a good neurological recovery. Bullets can fall from the posterior fossa with sufficient momentum to cause an acute spinal cord injury. Consideration for craniotomy and bullet retrieval should be given to large bullets lying in the CSF spaces of the posterior fossa as they pose risk for acute spinal cord injury.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Cheng
authors.forename: R Mark
authors.initials: RM
authors.lastname: Richardson
authors.forename: Alisa D
authors.initials: AD
authors.lastname: Gean
authors.forename: Shirley I
authors.initials: SI
authors.lastname: Stiver
mesh_terms: D002533:Cerebral Angiography; D003422:Critical Care; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000601:surgery; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010291:Paresis / Q000209:etiology / Q000628:therapy; D012540:Scapula / Q000293:injuries*; D013116:Spinal Cord; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult