Current concepts in penetrating and blast injury to the central nervous system. [Review]

MedStar author(s):
Citation: World Journal of Surgery. 39(6):1352-62, 2015 Jun.PMID: 25446474Institution: MedStar Washington Hospital CenterDepartment: RadiologyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Blast Injuries/su [Surgery] | *Brain Injuries/su [Surgery] | *Clinical Decision-Making | *Spinal Injuries/su [Surgery] | *Wounds, Gunshot/su [Surgery] | *Wounds, Stab/su [Surgery] | Age Factors | Blast Injuries/co [Complications] | Blast Injuries/ep [Epidemiology] | Brain Injuries/et [Etiology] | Brain/ra [Radiography] | Decompression, Surgical | Emergency Medical Services | Emergency Medicine | Glasgow Coma Scale | Humans | Neurosurgical Procedures | Prognosis | Pupil Disorders/di [Diagnosis] | Spinal Injuries/et [Etiology] | Spine/ra [Radiography] | Traumatology | Wounds, Gunshot/co [Complications] | Wounds, Gunshot/ep [Epidemiology] | Wounds, Stab/co [Complications] | Wounds, Stab/ep [Epidemiology]Year: 2015Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 1432-2323
Name of journal: World journal of surgeryAbstract: AIM: To review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing.CONCLUSIONS: Urgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4-5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.METHODS: A review of the current literature was performed.RESULTS: Of patients with craniocerebral GSW, 66-90% die before reaching hospital. Of those who are admitted to hospital, up to 51% survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13-17% of all gunshot injuries.All authors: Armonda R, Bell RS, Rosenfeld JVFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-01-15
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25446474 Available 25446474

Available online from MWHC library: 1997 - present, Available in print through MWHC library: 1999 - 2006

AIM: To review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing.

CONCLUSIONS: Urgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4-5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

METHODS: A review of the current literature was performed.

RESULTS: Of patients with craniocerebral GSW, 66-90% die before reaching hospital. Of those who are admitted to hospital, up to 51% survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13-17% of all gunshot injuries.

English

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