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Missile and Penetrating Injury
Anne G. Osborn, MD, FACR; Sheri L. Harder, MD, FRCPC
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Impalement injury
            • Stabbing injury
          • Definitions

            • Cranial trauma from high-velocity projectile (typically gunshot wound [GSW]) or impalement with sharp object

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Angiographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Grossbach AJ et al: Impalement brain injury from steel rod causing injury to jugular bulb: Case report and review of the literature. Brain Inj. 1-5, 2014
                                            2. Elserry T et al: Image guided surgery in the management of craniocerebral gunshot injuries. Surg Neurol Int. 4(Suppl 6):S448-54, 2013
                                            3. Syrmos N et al: Dealing with the surgical and medical challenges of penetrating brain injuries. Case Rep Surg. 2013:209750, 2013
                                            4. Kazim SF et al: Management of penetrating brain injury. J Emerg Trauma Shock. 4(3):395-402, 2011
                                            5. Agarwalla PK et al: An historical context of modern principles in the management of intracranial injury from projectiles. Neurosurg Focus. 28(5):E23, 2010
                                            6. Finley CJ et al: The demographics of significant firearm injury in Canadian trauma centres and the associated predictors of inhospital mortality. Can J Surg. 51(3):197-203, 2008
                                            7. Kim H et al: Intentional traumatic brain injury in Ontario, Canada. J Trauma. 65(6):1287-92, 2008
                                            8. McNett M: A review of the predictive ability of Glasgow Coma Scale scores in head-injured patients. J Neurosci Nurs. 39(2):68-75, 2007
                                            9. Aryan HE et al: Gunshot wounds to the head: gang- and non-gang-related injuries and outcomes. Brain Inj. 19(7):505-10, 2005
                                            10. Coşar A et al: Craniocerebral gunshot wounds: results of less aggressive surgery and complications. Minim Invasive Neurosurg. 48(2):113-8, 2005
                                            11. Kim KA et al: Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome. Neurosurgery. 57(4):737-47; discussion 737-47, 2005
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Impalement injury
                                                      • Stabbing injury
                                                    • Definitions

                                                      • Cranial trauma from high-velocity projectile (typically gunshot wound [GSW]) or impalement with sharp object

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Angiographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Grossbach AJ et al: Impalement brain injury from steel rod causing injury to jugular bulb: Case report and review of the literature. Brain Inj. 1-5, 2014
                                                                                      2. Elserry T et al: Image guided surgery in the management of craniocerebral gunshot injuries. Surg Neurol Int. 4(Suppl 6):S448-54, 2013
                                                                                      3. Syrmos N et al: Dealing with the surgical and medical challenges of penetrating brain injuries. Case Rep Surg. 2013:209750, 2013
                                                                                      4. Kazim SF et al: Management of penetrating brain injury. J Emerg Trauma Shock. 4(3):395-402, 2011
                                                                                      5. Agarwalla PK et al: An historical context of modern principles in the management of intracranial injury from projectiles. Neurosurg Focus. 28(5):E23, 2010
                                                                                      6. Finley CJ et al: The demographics of significant firearm injury in Canadian trauma centres and the associated predictors of inhospital mortality. Can J Surg. 51(3):197-203, 2008
                                                                                      7. Kim H et al: Intentional traumatic brain injury in Ontario, Canada. J Trauma. 65(6):1287-92, 2008
                                                                                      8. McNett M: A review of the predictive ability of Glasgow Coma Scale scores in head-injured patients. J Neurosci Nurs. 39(2):68-75, 2007
                                                                                      9. Aryan HE et al: Gunshot wounds to the head: gang- and non-gang-related injuries and outcomes. Brain Inj. 19(7):505-10, 2005
                                                                                      10. Coşar A et al: Craniocerebral gunshot wounds: results of less aggressive surgery and complications. Minim Invasive Neurosurg. 48(2):113-8, 2005
                                                                                      11. Kim KA et al: Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome. Neurosurgery. 57(4):737-47; discussion 737-47, 2005