Indian Journal of Neurotrauma 2011; 08(01): 53-55
DOI: 10.1016/S0973-0508(11)80028-6
Case report
Thieme Medical and Scientific Publishers Private Ltd.

Rare high cervical gunshot injury presenting as Brown – Sequard syndrome: Management dilemmas

Ashish Kumar
,
PN Pandey
,
Arshad Ghani
,
Gaurav Jaiswal

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

Spinal trauma due to missile/gunshot injuries has been well reported in the literature and has remained the domain of military warfare more often. The chief neurosurgical concern in these types of firearm injuries is the degree of damage sustained during the bullet traversing through the neural tissue and the after effects of the same in long term. Sometimes, though their management can be tricky and may pose certain management dilemmas. We report an interesting case of a penetrating bullet injury to cervical spine at C2 vertebral level presenting as Brown Sequard syndrome. Not only the site was unusual, this patient also posed few treatment related issues. The clinical presentation, imaging and the management of the patient are discussed along with relevant literature regarding gunshot injuries to spine.

 
  • References

  • 1 Mangiardi JR, Alleva M, Dynia R, Zubowski R. Transoral removal of missile fragments from the C1 – C2 area: report of four cases. Neurosurgery 1988; 23: 254-257
  • 2 Maniker AH, Gropper MR, Hunt C.D.. Transoral gunshot wounds to the atlantoaxial complex: Report of five cases. J Trauma 1994; 37: 858-861
  • 3 Heiden JS, Weiss MH, Rosenberg AW, Kurze T, Apuzzo ML. Penetrating gunshot wounds of the cervical spine in civilians. Review of 38 cases. J Neurosurg 1975; 42: 575-579
  • 4 Kafadar AM, Kemerdere R, Isler C, Hanci M. Intradural migration of a bullet following spinal gunshot injury. Spinal Cord 2006; 44: 326-329
  • 5 Benzel EC, Hadden TA, Coleman JE. Civilian gunshot wounds to the spinal cord and cauda equina. Neurosurgery 1987; 20: 281-285
  • 6 Gupta S, Senger R. Wandering intraspinal bullet. Br J Neurosurg 1999; 13: 606-607
  • 7 Oktem I, Selcuklu A, Kurtsoy A, Kavuncu I, Pasaoglu A. Migration of bullet in the spinal canal: a case report. Surg Neurol 1995; 44: 548-550
  • 8 Linden M, Manton W, Stewart R, Thal E, Feit H. Lead poisoning from retained bullets. Pathogenesis, diagnosis, and anagement. Ann Surg 1982; 195: 305-313
  • 9 Tindel N, Marcillo A, Tay B, Bunge R, Eismont F. The effect of surgically implanted bullet fragments on the spinal cord in a rabbit model. J Bone Joint Surg 2001; 83: 884-890
  • 10 Grogan DP, Bucholz RW. Acute lead intoxication from a bullet in an intervertebral disc space. A case report. J Bone Joint Surg Am 1981; 63: 1180-1182
  • 11 Klimo Jr P, Ragel BT, Rosner M, Gluf W, McCafferty R. Can surgeryimprove neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus 2010; 28: 1-11
  • 12 Levy ML, Gans W, Wijesinghe HS, SooHoo WE, Adkins RH, Stillerman CB. Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury:outcome analysis. Neurosurgery 1996; 39: 1141-1149
  • 13 Gupta SK, Gupta S, Bajaj A, Mohindra S, Khosla VK. Bullet injury to the atlanto-axial region. Neurol India 2006; 54: 216-217