Deadly cerebral ischemia due to carotid stenosis following a facial shot with a pellet gun: An autopsy case report

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Published Jul 28, 2024
https://doi.org/10.62438/tunismed.v102i8.5045
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Vol. 102 No. 8 (2024): Tunis Med aug 2024

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Sarra Ben Abderrahim
Forensic Medicine Department, Ibn El Jazzar University Hospital, Kairouan. Ibn El Jazzar Faculty of Medicine, University of Sousse, Sousse, Tunisia
https://orcid.org/0000-0001-6362-5532
Fatma Daoud
Forensic Medicine Department, Habib Bourguiba University Hospital, Sfax. Faculty of Medicine of Sfax, university of Sfax, Tunisia
Elyes Turki
Forensic Medicine Department, Ibn El Jazzar University Hospital, Kairouan. Ibn El Jazzar Faculty of Medicine, University of Sousse, Sousse, Tunisia
Raja Ghzel
Emergency Department, Ibn El Jazzar University Hospital, Kairouan. Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
Malek Zribi
Forensic Medicine Department, Habib Bourguiba University Hospital, Sfax. Faculty of Medicine of Sfax, university of Sfax, Tunisia

Abstract

Introduction: Facial gunshot wounds have devastating functional and aesthetic consequences for the patient. If associated with penetrating craniocerebral injuries, the prognosis is rather compromised even with appropriate medical and surgical treatment. Chop-off injuries with penetrating wounds constitute a challenging situation for the facial reconstructive surgeon in facial trauma.


Observation: This case involved a 49-year-old man who sustained an accidental facial shot from a pellet gun. Radiological and clinical investigations revealed complex ballistic trauma to the maxillofacial region, with projectiles reaching the base of the skull. One of the projectiles migrated via the carotid canal towards a cerebral artery, leading to obstruction of the artery with cerebral infarction. An autopsy was performed which evaluated that the shooting distance was compatible with a long distance, causing the dispersion of lead grains with the absence of a wad inside the trauma site.


Conclusion: In some cases of facial gunshot wounds, despite a complex and extensive lesion assessment, death may occur due to a neurological complication rather than sustaining hemodynamic shock, depending on the trajectory of the projectiles

Keywords:

autopsy, facial trauma, forensic pathology, gunshot

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