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Civilian Firearm-Inflicted Brain Injury: Coagulopathy, Vascular Injuries, and Triage

  • Neurotrauma (D. Sandsmark, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Civilian firearm-inflicted penetrating brain injury (PBI) carries high morbidity and mortality. Concurrently, the evidence base guiding management decisions remains limited. Faced with large volume of PBI patients, we have made observations in relation to coagulopathy and cerebrovascular injuries. We here review this literature in addition to the question about early prognostication as it may inform neurosurgical decision-making.

Recent Findings

The triad of coagulopathy, low motor score, and radiographic compression of basal cisterns comprises a phenotype of injury with exceedingly high mortality. PBI leads to high rates of cerebral arterial and venous injuries, and projectile trajectory is emerging as an independent predictor of outcome.

Summary

The combination of coagulopathy with cerebrovascular injury creates a specific endophenotype. The nature and role of coagulopathy remain to be deciphered, and consideration to the use of tranexamic acid should be given. Prospective controlled trials are needed to create clinical evidence free of patient selection bias.

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Acknowledgements

We are indebted to the neurosciences critical care unit nurses at UCMC for their meticulous expert care of the cohort of patients reported here and to the multiple trainees and consultant physicians involved in their care.

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Authors and Affiliations

  1. Department of Neurology, University of Chicago Medical Center, Chicago, IL, USA

    Christos Lazaridis, Ali Mansour, Ronald Alvarado-Dyer, Ruth Tangonan, Andrea Loggini, Christopher Kramer & Fernando D. Goldenberg

  2. Department of Neurosurgery, University of Chicago Medical Center, Chicago, IL, USA

    Christos Lazaridis, Ali Mansour, Christopher Kramer & Fernando D. Goldenberg

  3. Division of Neurocritical Care, Departments of Neurology, and Neurosurgery, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Christos Lazaridis, Ali Mansour, Christopher Kramer & Fernando D. Goldenberg

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  1. Christos Lazaridis
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Correspondence to Christos Lazaridis.

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All reported studies with human subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Lazaridis, C., Mansour, A., Alvarado-Dyer, R. et al. Civilian Firearm-Inflicted Brain Injury: Coagulopathy, Vascular Injuries, and Triage. Curr Neurol Neurosci Rep 21, 47 (2021). https://doi.org/10.1007/s11910-021-01131-0

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