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Am J Emerg Med. 2012 Nov;30(9):2089.e5-7. doi: 10.1016/j.ajem.2011.12.029. Epub 2012 Mar 3.

High-velocity gunshot to the head presenting as initial minor head injury: things are not what they seem.

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Section of Neurosurgery, Hospital Amerimed, Puerto Vallarta 48310, Mexico.


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.

[Indexed for MEDLINE]

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