A patient with a low Glasgow Coma Scale (GCS) and pupillary abnormalities following a gunshot wound to the brain usually has a poor prognosis. Lin et al identified factors predictive of a good outcome in these patients. The authors are from Beth Israel Deaconess Medical Center in Boston.

Patient selection: gunshot wound to the brain, Glasgow coma scale less than 5 on admission


Factors associated with a better outcome - all of the following:

(1) time from injury to surgical intervention less than 1 hour

(2) injury to noneloquent brain

(3) no injury to midbrain, brainstem and major vessels


Patients often require a hemicraniectomy because of cerebral swelling.

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