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Washington University Experience | VASCULAR | Herniation, tonsillar | 5A0 Case 5 History
Case 5 History ---- The patient was a 51-year old man with a long history of depression admitted for an apparently self-inflicted .22 caliber gunshot wound to the right temporal area. Upon arrival at BJH, the patient was unresponsive. His Glasgow Coma Score (GCS) was 3. On arrival circulation and pulses were intact with no active external hemorrhage, pupils were fixed at 3 mm, no spontaneous movement was present, and a wound was noted to the right temporal region. Corneal and gag reflexes were absent. Toxicology studies revealed a serum ethanol level of 199 and a positive screen for benzodiazepines in a urine sample. He had no response to cold calorics. The patient was transferred to the Neurosurgical ICU for further stabilization and to ascertain whether he was a potential organ donor. The patient was declared “Brain Dead” following two failed apnea tests. CT showed the bullet entered through the squamous portion of the right temporal bone, traversed obliquely through the thalamus toward the left posterior parietal lobe where it lodged. Subarachnoid, subdural, and intraventricular hemorrhages were present. He died shortly thereafter.
