a bullet just stuck in left hemisphere of brain without any serious injury but removal of bullet may result to coma
what should be done in this case?
Answers
Answer:
Gunshot wound head-trauma patients are aggressively resuscitated upon initial arrival at the hospital. If blood pressure and oxygenation can be maintained, an urgent CT scan of the brain is obtained. The decision to proceed with surgical treatment of the gunshot wound is based on these factors:
The level of consciousness: Glascow Coma Scale 1-15 (GCS); a patient with any score less than seven or eight is considered to be in coma;
The degree of brainstem neurological function; and
CT scan findings.
If patients are deeply comatose with minimal evidence of brainstem function and no evidence of an intracranial hematoma that might be causing the coma, a fatal outcome is nearly certain. If a hematoma is confirmed by CT scan, an emergency craniotomy for clot evacuation, removal of debris and devitalized tissue may be performed. It is common for pressure to build up within the skull, so a craniectomy (a procedure in which a large portion of the skull is temporarily removed to decrease pressure inside the skull) is also often performed.
Understanding the trajectory of the bullet path is important in determining prognosis. The brain is divided into two hemispheres made up of four lobes each, with each lobe providing different functions. Additionally, there are deeper parts of the brain that house many connections, controlling basic body and brain functions. The cerebellum in the back lower part of the brain is related to motor coordination. The brainstem connects the upper portion, or "thinking" portions of the brain, to the spinal cord.
Outcome is poorer for those with extensive bullet tracts, those that cross the deep midline structures of the brain or those that involve the brainstem. A bullet that damages the patient's right hemisphere can leave the victim with motor and sensory impairments on the left side and vice versa. Many other functions such as cognition, memory, speech and vision are controlled by both sides of the brain. As a result, damage to one hemisphere can leave a person impaired but still able to perform these functions at some level, depending on which lobes of the brain are damaged.
Because each hemisphere is divided into four lobes, the "best-case scenario" is a more superficial injury limited to one hemisphere and a single lobe, limiting the functional impairments caused by the trauma. The first week or two after trauma is the acute and critical-care stage. After that, the extent and speed of recovery depends on how much tissue was damaged, the degree of swelling, pressure inside the head during the acute stage and the functional consequences of the damage. Intensive rehabilitation may be necessary to help survivors regain some of their functions or to adapt to permanent deficits. Neurological recovery is measured in terms of several months or even years.
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