718 Cryptogenic Stroke in a Patient with Firearm Injury - a Diagnostic Dilemma

Abstract Introduction Neurological deficit associated with firearm injury outside the head and neck region is a rare phenomenon. Multiple explanations, including pellet embolization, patent foramen ovale carotid intimal tear, have been suggested. Case Report We present case of an otherwise healthy 21-year-old male, who was received in emergency injury, unstable vitals, GCS 14/15. Bullet entry wound on back chest, 3 cm medial to spine left scapula, no exit wound, but bullet palpable superior 1/3rd right clavicle. CT X-ray imaging confirmed surgical emphysema sided haemopneumothorax. Two release incisions were given both clavicles. found below incision retrieved. Chest tube inserted bilaterally, patient placed mechanical ventilation. On 5th day, upon resolution haemopneumothorax, extubated, chest tubes removed. However, examination findings revealed facial abducens palsy along circumduction gait. MRI brain showed ischaemic changes frontoparietal region. Carotid angiography echocardiography normal. Patient then managed by neurology neurosurgery. Conclusion In cases physician should always look for neurological deficits, irrespective pathway through body. Stroke be concern such even if young.