Citation

Abla AA, Albuquerque FC, Theodore N, Spetzler RF. Neurosurgery 2011; 68(6): E1750-4; discussion E1754-5.

Affiliation

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Copyright

(Copyright © 2011, Congress of Neurological Surgeons)

DOI

10.1227/NEU.0b013e31821713fb

PMID

21389897

Abstract

BACKGROUND AND IMPORTANCE:: To present a case of traumatic cortical and dural AVF after a BB gun accident. CLINICAL PRESENTATION:: The patient presented with a small left frontal subdural hematoma and small contusions in the left frontal lobe after he was shot with a BB. He had no skull fractures or significant midline shift. The patient, who was neurologically intact, was discharged after 3 days of observation undergoing serial imaging. Five days later, the patient developed lethargy and emesis. CT showed a 5 x 3 x 5 cm intraparenchymal hematoma in the left frontal lobe. Emergency evacuation of the hematoma revealed a cortical arteriovenous fistula (AVF), which was resected. Postoperative angiography showed a dural AVF of the left middle meningeal artery, draining into the superior ophthalmic vein and a dural vein. The dural AVF was embolized with n-butyl cyanoacrylate. The patient was discharged after 3 days with no defecits. CONCLUSION:: The subdural hematoma and contusions were caused by a BB, which are often used in low-velocity and small caliber weapons. Not all BB guns are low velocity, and the consequences can be dramatic. The BB gun used here was pneumatic. The patient had no skull fractures. Several days of stable imaging and normal examinations suggested nothing sinister. His initial bleeds appeared disproportionate to the mechanism. The delayed presentation of the debilitating hematoma in this case stresses the need for vigilance on the part of practitioners and families when patients have a suspicious bleed.

Language: en