A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment
- 14 January 2017
- journal article
- review article
- Published by Springer Science and Business Media LLC in Emergency Radiology
- Vol. 24 (3), 301-309
- https://doi.org/10.1007/s10140-016-1477-z
Abstract
Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries. Post-traumatic complications, including intracranial infections, cerebrospinal fluid leaks, traumatic intracranial aneurysms, intraventricular hemorrhage, dural venous sinus thrombus, and bullet fragment migration, also have specific imaging features and serious treatment implications. In this article, we review the initial imaging evaluation of penetrating brain injury using computed tomography with and without angiography. We also describe the imaging features of various post-traumatic complications and their treatment implications. Finally, we discuss the clinical and imaging parameters that serve as important prognostic indicators and the surgical management.Keywords
This publication has 28 references indexed in Scilit:
- Dual-Energy CT–Based Monochromatic ImagingAmerican Journal of Roentgenology, 2012
- Management of penetrating brain injuryJournal of Emergencies, Trauma, and Shock, 2011
- Endovascular Management of Neurovascular Arterial Injuries in the Face and NeckSeminars in Interventional Radiology, 2010
- Contemporary Management of Penetrating Brain InjuryNeurosurgery Quarterly, 2009
- Radiologic Diagnosis of Cerebral Venous Thrombosis: Pictorial ReviewAmerican Journal of Roentgenology, 2007
- Penetrating Gunshot Injuries to the BrainThe Journal of Trauma and Acute Care Surgery, 2007
- CT Angiography “Spot Sign” Predicts Hematoma Expansion in Acute Intracerebral HemorrhageStroke, 2007
- Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and managementJournal of Neurosurgery, 1996
- Penetrating gunshots to the head and lack of immediate incapacitationInternational journal of legal medicine, 1995
- Early complications following penetrating wounds of the brainJournal of Neurosurgery, 1971