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|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 207-208
Rare case of cerebral contusion due to shock waves following firecracker explosion
Ashis Patnaik1, Ashok Kumar Mahapatra2
1 Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar, Odisha, India
2 Department of Neurosurgery, All India Institute of Medical Science, Bhubaneswar, Odisha, India
|Date of Submission||11-Feb-2014|
|Date of Decision||13-Feb-2014|
|Date of Acceptance||08-Apr-2014|
|Date of Web Publication||14-May-2014|
Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patnaik A, Mahapatra AK. Rare case of cerebral contusion due to shock waves following firecracker explosion. Neurol India 2014;62:207-8
Cerebral contusions are common lesions in context of traumatic brain injury and are often associated with other lesions such as subdural hematoma, subarachnoid hemorrhage, extradural hematoma, etc., However, contusion due to severe shock wave without physical trauma is quite peculiar and has never been reported in the literature. We report one such rare case.
A 42-year-old male patient presented with the complaints of intense headache and two episodes of vomiting 20 h after getting exposed to an accidental explosion of a firecracker close to his right side temple region (barely one foot). Immediately, following the incident, he felt dizziness with slight difficulty of hearing. However, there was no loss of consciousness and seizures. He denied any history of foreign body impact on the head. Examination revealed no localized bruise, lacerations or wound over the head [Figure 1]a and b. There was no entry wound or burn marks suggestive of contact of the exploded material to the head. Neurologic examination was normal. Noncontrast computed tomography head scan revealed right temporal small contusion with minimal perilesional edema without any mass effect or shift [Figure 2]. There was no evidence of skull bone fractures. Patient was treated conservatively with, which headache and vomiting subsided within 3 days and patient discharged.
|Figure 1: (a and b) Image of the patient showing no abrasion, lacerations, bruise or swelling over any part of the head|
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|Figure 2: Computed tomography scan showing a small temporal contusion on the right side with no mass effect or fracture of skull bones|
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Shock waves due to blast of improvised explosive devices have been known to cause various types of neurological disorders, particularly the cognitive deficits. These were recently well recognized by the neurosurgeons involved in US operations in Iraq and Afghanistan.  The injuries caused by shock waves arising out of the explosion of such devices is actually a two stage phenomenon: First shock wave crushes the brain against the moving skull; second shock wave is generated by the huge volume of air flooding back into the impacted area under high pressure due to the void caused by the first wave.  The second shock wave, also known as rarefication wave or negative shock wave, may cause more damage than the initial shock wave or incident wave due to its cavitation effects.  Although in our case, the explosion was that of a fire cracker, the very short distance of less than a foot may have caused the severe shock waves leading to disruption of parenchymal capillaries leading to the contusion. Contusion usually occurs as a counter-coup phenomenon on the opposite side of impact and the present case of contusion on the same side of explosion, supports the shock waves without any physical damage causing the contusion.
Even after thorough history taking, physical evidence and investigation (lack of fracture in computed tomography scan), we could not find any evidence of physical contact of an object or impact to the head as the cause of contusion. Although, various types of cognitive deficits have been described following blast injury effect on nervous system, structural lesions of brain caused by shock wave lack reporting. We conclude that such type of structural lesions like contusion could well be caused by subtle civilian incidents involving strong shock waves, in comparison to war conditions or bomb explosions where the role of blast causing shock waves and neural injury has been well-established.
| » References|| |
|1.||Glasser R. Shock wave of brain injuries. Washington Post. April 8, 2007. http://www.washingtonpost.com/wp-dyn/content/article/2007/04/06 /AR2007040601821_pf.html. [Last accessed on 2008 Nov 14]. |
|2.||Chen Y, Constantini S. Caveats for using shock tube in blast-induced traumatic brain injury research. Front Neurol 2013;4:117. |
|3.||Nakagawa A, Manley GT, Gean AD, Ohtani K, Armonda R, Tsukamoto A, et al. Mechanisms of primary blast-induced traumatic brain injury: Insights from shock-wave research. J Neurotrauma 2011;28:1101-19. |
[Figure 1], [Figure 2]