title: Penetrating brain injury: a case report.
abstract: BACKGROUND
  Gunshot wounds as a result of attempted suicide, criminality or warfare comprise a significant group among penetrating injuries of the brain. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high, up to 98.5%. Although there are also many other prognostic factors for high mortality, such as damage to the ventricular system or the involvement of two or more lobes, GCS score seems to be the most important determinant. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improve the prognosis and final outcome.
  
  
  METHODS
  The authors present the case of a 27-year-old man who suffered a gunshot wound to the right temporal region, self-inflicted from an air-gun. On admission to the intensive care unit he received a score of 3 points on the GCS. There were also other negative prognostic factors - the pellet penetrated two lobes and damaged the third ventricle. Despite the serious prognosis, the appropriate multiprofile treatment and rehabilitation resulted in unexpectedly good recovery. Two years after the trauma the patient was conscious, maintained logical verbal contact, and was able to walk using a walking-aid.
  
  
  CONCLUSIONS
  Rapid transport to a major trauma center is essential for patients with penetrating brain injury. Among all interventions it seems essential to provide the prevention of posttraumatic nervous tissue damage and associated neurological dysfunction.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia in Katowice, Poland. kasia.smilowska@gmail.com.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Śmiłowska
authors.forename: Justyna
authors.initials: J
authors.lastname: Pytel
authors.forename: Lech
authors.initials: L
authors.lastname: Krawczyk
authors.forename: Marek
authors.initials: M
authors.lastname: Śmiłowski
authors.forename: Przemysław
authors.initials: P
authors.lastname: Jałowiecki
mesh_terms: D000328:Adult; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis; D013406:Suicide, Attempted; D014948:Wounds, Gunshot / Q000503:physiopathology / Q000534:rehabilitation*