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JAMA 100 Years Ago
August 4, 2010

Gunshot Wound of Brain

JAMA. 2010;304(5):585. doi:10.1001/jama.2010.1016

In the first case cited by DaCosta a No. .22 bullet was lodged in the brain for eight months, producing amnesia and convulsions. It was removed successfully. Convulsions were arrested but the amnesia was not improved. In this patient the shock caused partial amnesia; the bullet, encysted just beneath the cortex, caused convulsions, and DaCosta suggests that in all probability, when the tearing loose of the bullet from the wall which encysted it took place, the bullet moved about and the irritation led to the development of status epilepticus. An interesting fact is that a No. .22 bullet should have pierced an ordinary thick skull and reached the opposite side of the head. In the second case, a bullet of .32 caliber, in the brain for over four weeks, caused violent headache and was successfully removed with complete recovery. The bullet was lodged in the falx and against the superior surface of the straight sinus. The whirr of the blood in that sinus was very distinct as the finger pushed against the bullet. The falx was incised, the bullet was exposed and removed with bullet forceps. On its removal there was a great gush of blood, presumably from the sinus. The bleeding was arrested by gauze packing which made much pressure on the falx and tentorium. Because of the large amount of gauze employed, the fear of further hemorrhage, and the apprehension as to the results of compression, the bone flap was removed and the scalp sutured about the protruding gauze. The man reacted quickly from the ether and a few hours after the operation was perfectly conscious and free from pain. The packing was not removed for nine days. On its removal there was no bleeding. The patient at present is in excellent health.

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