RESUMO
Surviving a gunshot wound to the head is a rare event, particularly in the past when medical treatment was much less advanced than it is today. Moreover, the finding of such a case as an identified specimen within a museum collection is even more uncommon. This led us to report on this unique case in this paper as it poses a challenge to forensic anthropology and provides a unique educational oppourtunity. The skull from the Collection at the Cranium Museum in the Department of Morphology and Genetic at the Federal University of São Paulo (UNIFESP) dates back to 1946. For trauma registration the bone location, severity, trauma aetiology, trauma classification, description, callus formation, periosteal reaction, degree and success of repair, and an estimate of the time elapsed since the trauma, were all assessed. To explore the case radiologically a CT scan of the skull was performed. Considering the survival of the patient and the morphology of the wound it is likely that the injury was caused by a small calibre, low-velocity gunshot. The bullet path shows an almost vertical direction on the right side of the individual's splanchno and neurocranium. The path of the projectile is consistent with a suicide attempt, although the possibility of a homicide simulating a suicide cannot be discarded. This case highlights how informative such cases can be to the practice of forensic anthropology.
Assuntos
Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/patologia , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/patologia , Adulto , Consolidação da Fratura , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The objective of this study is to present a case series of nonmissile penetrating (NMP) injuries and to establish a workflow for an uncommon mechanism of traumatic head injury through the analysis of each case, classification of the type of lesion, management, and outcome score at follow-up. METHODS: From January 1991 to December 2008, 36,000 patients presenting with traumatic brain injury (TBI) were admitted in the Department of Neurosurgery, Hospital Antônio Targino, Campina Grande-PB, Brazil. From these patients, 11 presenting with lesions caused by NMP objects were selected. RESULTS: Among the 11 patients, 9 were men and 2 were women. Their ages ranged from 7 to 74 years old (mean age ± SD, 29.1 ± 22.99 years). All patients underwent neuroradiologic evaluation. The entry point was classified as natural (orbit) or artificial (skull transfixation), and we also divided the patients presenting with secondary parenchymal or vascular damage from those presenting with only lesions caused by the primary penetration into the cranium and meninges. All patients were neurosurgically treated with removal of the foreign body through craniotomy, except the patient whose object (pen) was removed without craniotomy with local anesthesia. Glasgow Coma Scale (GCS) score on admission was a statistically significant factor on prognosis, and any patient who presented with a GCS score of 15 evolved satisfactorily, and there were no deaths in this group of patients (P = 0.04). CONCLUSIONS: TBIs caused by NMP objects are unusual and caused by aggression, self-inflicted harm (in the case of psychiatric patients), and accident. The foreign body may enter into the skull through a natural hole (orbit, nose, mouth, or ear) or crosses the skull, causing a fracture and creating an artificial hole. Preoperative neuroradiologic assessment is paramount for the correct neurosurgical approach. The main prognostic factor for these patients is the GCS score at admission.
Assuntos
Traumatismos Cranianos Penetrantes/cirurgia , Acidentes , Adolescente , Adulto , Idoso , Criança , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/patologia , Corpos Estranhos/cirurgia , Escala de Coma de Glasgow , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/etiologia , Traumatismos Cranianos Penetrantes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Prognóstico , Comportamento Autodestrutivo/diagnóstico por imagem , Comportamento Autodestrutivo/patologia , Comportamento Autodestrutivo/cirurgia , Violência , Adulto JovemRESUMO
Scanning electron microscopy (SEM) has been used in forensic science in many ways. The reports of cases in which SEM has been used as an auxiliary method in the investigation of exhumed bones are rare. In this article, we report an exhumation that was made to determine if a seized weapon could have been used in a homicide. We used SEM to analyze a fracture in the interior of the skull of the victim. The findings described in this article showed us that it is possible to develop new researches in this field.
Assuntos
Exumação , Microscopia Eletrônica de Varredura , Fraturas Cranianas/patologia , Adulto , Antropologia Forense , Patologia Legal , Traumatismos Cranianos Penetrantes/patologia , Homicídio , Humanos , Masculino , Transiluminação , ArmasRESUMO
INTRODUCTION: The original descriptions of the frontal lobe injury of Phineas Gage (1848) and the slowly growing tumor of 'Tan', Broca's famous patient (1861), are examples of how a simple case report can teach important lessons, some of them still discussed a century and a half later. DEVELOPMENT: In this article, the original sources of both of these seminal cases, in Boston and Paris, have been reviewed and are briefly summarized. The lessons learned from them in the effort to localize brain functions are explained and set in the context of modern evidence-based medicine.
Assuntos
Neoplasias Encefálicas/fisiopatologia , Traumatismos Cranianos Penetrantes/patologia , Neurociências/educação , Neurociências/história , Boston , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , História do Século XIX , Humanos , ParisRESUMO
Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. Ten patients had surgery, two of whom died. Six complications occurred: two patients each developed an infection, cerebrospinal fluid fistula or seizures. All patients were victims of an assault and all had intracranial penetration, the most common sites of which were facial and frontal. Median hospital stay was eleven days. The Glasgow Coma Score on admission was a good prognostic indicator. Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault.
Assuntos
Traumatismos Cranianos Penetrantes , Ferimentos por Arma de Fogo , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/patologia , Traumatismos Cranianos Penetrantes/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Violência , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/patologia , Ferimentos por Arma de Fogo/terapiaRESUMO
Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. Ten patients had surgery, two of whom died. Six complications occurred: two patients each developed an infection, cerebrospinal fluid fistula or seizures. All patients were victims of an assault and all had intracranial penetration, the most common sites of which were facial and frontal. Median hospital stay was eleven days. The Glasgow Coma Score on admission was a good prognostic indicator. Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault