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Home >Online Support Ask The Experts >Judy Melinek, M.D.

Judy Melinek (Pathology Expert)

My 16 year old son was recently shot in the back of the head using a .357. The bullet was lodged into his occipital lobe and unable to be removed. The first CT scan showed brain damage in the right hemisphere. Doctors performed a bone flap. After hours of surgery, the doctor told me he was "stable for now" but in his experience, patients usually do not survive. After a few hours in ICU (my mson was on life support the whole time) nurses told me they needed to do another CT scan. This was about 12 hours after initial injury. Second CT scan showed damage had spread to also the left hemisphere AND the brainstem. He was pronounced brain dead the next day. I know the doctors did everything they could, even borrowing equipment from another hospital for some kind of neuro-flow scan. It was explained to me that the bullet would never be able to be removed and that it spread in his brain "like a firecracker."
    My questions for you are: what would his chances have been with a bullet wound to the occipital lobe? Why did it spread? Was it the result of swelling? What if I would have requested my son be transferred to a better hospital? What would the result have been if they could have removed the bullet? Why did the doctors tell me I didn't have an option to leave him on life support for a few more days? Could he have actually survived this head injury, or am I grasping at straws? Could I have pushed for something different/more to possibly save his life?

I can't comment on your son's case without having access to the medical records, CT scans and autopsy report. Best I can do from the information you gave me is to tell you that bleeding in the brain can appear to "spread" from one CT scan to the next and that it is very hard to give a family of the likelihood of a positive outcome based on one scan - you have to see what happens over time. It's the bleeding that "spreads" - not the bullet. Bullets don't "move around" in the head - they generally stay in place. Generally every time there is brain injury (whether it is penetrating like in a gunshot wound, or closed head injury as in a fall or beating) the brain responds by swelling and given the rigid nature of the skull, the swelling can make things worse and cause death by pressing on vital centers. I don't think that second-guessing the choices you made at the end of his life will help you understand things better or give you comfort. The likelihood is that he would not have survived regardless of where he went for care - I'm saying that because few people survive a .357 wound to the head. Survival depends on the type of injury and the location of the brain that is injured, more than it does on the speed and quality of the neurosurgical care. Removing a bullet is rarely helpful  - on fact, it can be worse because the surgery is more disruptive than just leaving it there. I hope this helps. Please reach out to others who have experienced such a loss. Many other parents are there who have ben through this and can help you get through this dark time. I am forever grateful that you reached out to me and I hope my words can help you heal.

- Judy Melinek