Presentation
Self inflicted injury.
Patient Data
There is a large parenchymal hematoma measuring within the right hemisphere. A metallic density consistent with a bullet is lodged within the frontal lobe less than 1cm from its entry site through the parietal bone. Within the hemorrhage there are innumerable tiny metallic densities (presumably related to the bullet fragments), and numerous parietal bone fragments (these bone fragments extend 5cm into the parenchyma). The hematoma has significant mass effect on the right lateral ventricle and there is midline shift of 12mm to the left measured at the septum pellucidum. No tonsilar herniation.
Blood layers within the occipital horns of the lateral ventricles. There is hydrocephalus. Subarachnoid blood is present in the right cerebral sulci. A subdural hematoma layers over the right cerebral hemisphere measuring up to 6mm in maximal depth.
Frontal and temporal lobe contusions are present secondary to the shockwave.
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