Raining Bullets

Traumatic brain injury in times of war, patriotism and sports
(June 5, 2012)
By Michelle Rabell

The thundering of gunfire jolts neurosurgeon Dr. James Ecklund from the shower at his military base in Baghdad. It is a sure sign of an attack.

Rushing outside, he sees tracers and small explosions of gunfire lighting the night sky. He assumes the base is under attack.

A British military contractor also hears the shouts and distant shots as he walks home from a pub. Then he feels something hit him on the top of the head.  Reaching up, he touches a small object that is slightly protruding from his scalp. He gets a sudden headache.

There has been combat, alright, but on the soccer field. The Iraqi National Soccer team has just defeated Iran. In this country where many men carry a weapon instead of a briefcase, the shooting is in celebration of a sports victory between rival countries. Shooting into the air is an expression of national pride.

This is where law of gravity comes in; what goes up must come down. And what are the chances that one of those celebratory bullets would careen down onto someone’s head?

In the case of the British contractor, the chances were pretty good. The night’s shower of bullets brought more than loud noise and distraction. It landed a bullet in his head.

This incident occurred in 2005. Surprisingly, the British contractor wasn’t knocked unconscious, didn’t experience dizziness or show any signs of distress. He just got a headache and felt a bit of blood on the top of his head.  What he didn’t know was that he had just suffered was a traumatic brain injury.

This sort of brain injury doesn’t occur frequently in the US, but in other parts of the world, research tells a very different story. While injuries such as this are different from the kind of wounds inflicted by direct gunfire, they can be just as dangerous if not handled correctly.

Back at the hospital, a CT scan showed that the bullet had penetrated the man’s brain, but not entirely. It was lodged in his skull.  He was given antibiotics, a tetanus shot and taken to the operating room, where Dr. Ecklund and his team removed the bullet.

A patient with this type of injury could bleed to death if the bullet were removed by a non-specialist without the benefit of a brain CT scan and other lab tests that provide clues as to the surgical approach that would produce the best outcome.

Luckily for this man, his neurosurgeon was well experienced in handling traumatic brain injuries. Thanks to Dr. Ecklund and his neurosurgery team, the man fully recovered.

For the British contractor, there was no question what he would do with his new lease on life. When informed by Dr. Ecklund and his team that he would recover well enough from his frontal lobe injury to stay on in Baghdad, the man replied, “No mate. I figure my luck’s run out.”

James M. Ecklund, MD, is an internationally recognized neurosurgeon and medical director at Inova Neuroscience Institute.

 A study referencing this case was written by James Ecklund, MD, and his neurosurgery team, Evan M. Renz, MD; Geoffrey Ling, MD, PhD; Kevin J. Mork, MD, and published in the Archives of Surgery, April 2012 edition.