title: High-velocity gunshot to the head presenting as initial minor head injury: things are not what they seem.
abstract: Tangential gunshots to the head are a special type of injury in which the bullet or bullet fragments do not penetrate the inner table of the skull. Most of patients experiencing this kind of injuries usually have a benign clinical presentation. We describe the case of a 22-year-old soldier who had a tangential gunshot to the head caused by a high-velocity projectile. Initially, the patient was neurologically intact, progressing to profound coma in the next 2 hours. The characteristics of the wound and initial neurologic condition led to first contact physicians to treat this injury as a case of mild head trauma. This case shows us that gunshots to the head caused by high-velocity missiles must be treated aggressively like a severe head injury, even when the initial neurologic examination is normal.
authors.affiliation: Section of Neurosurgery, Hospital Amerimed, Puerto Vallarta 48310, Mexico. larob@prodigy.net.mx
authors.forename: Luis A
authors.initials: LA
authors.lastname: Robles
mesh_terms: D006259:Craniocerebral Trauma / Q000175:diagnosis; D003951:Diagnostic Errors; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D059906:Neuroimaging; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055815:Young Adult