Birdshots in brain.

Sir,

Cranial traumas from birdshot wounds are serious and life-threatining injuries. Although penetrating brain injury (PBI) is less frequent than closed head trauma, it carries a worse prognosis.[1] Computerized tomography (CT) scan is essential in the emergency setting for initial evaluation of traumatic bone and parenchymatous injuries to determine the indication of neurosurgery and for appropriate medical management. However, CT is recommended as the neuroradiologic modality of choice for the PBI patients.[1] The most significant problem with CT in bridshot wounds is metallic streak artifact.[2] A 2-year-old boy was admitted to the pediatric intensive care unit for eye and brain injury. He had been wounded by birdshot. Cranial CT showed multiple hyperdense birdshots with streak artifacts within the posterior fossa and the occipital lobe [Figure 1a and b]. The birdshots located in orbita bones and different regions of the brain were evaluated as inoperable by neurosurgeons. In patients with gunshot wound in brain, the length of bullet track, the location, and the number of ricochets have a direct correlation with prognosis.[2] Also, intraventricular hemorrhage and bi- or multilobar injury predict poor prognosis.[3] Our patient had long bullet tracks (from orbita to occiput) without intraparenchymal and intraventricular hemorrhage.

Figure 1

Axial consecutive CT images show multiple hyperdense birdshots with streak artifacts within the posterior fossa (a) and the occipital lobe (b). No prominent intraparenchymal hemorrhage is seen. Note the small amount of subdural effusion over the left frontal lobe

Although birdshot injuries in brain are life-threatining traumas, our patient was discharged without any neurological deficiency despite many number of the birdshots and long bullet tracks in the brain. The prognosis of the patients with birdshot injury in brain with long bullet tracks may be good if there is no intraparenchymal or intraventricular hemorrhage.