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Images in Neurology | July 2000

Souvenir From War

John T. Paul, MD, PhD

Arch Neurol. 2000;57(7):1073. doi:10.1001/archneur.57.7.1073.

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IN MARCH 1991, a soldier stationed in Iraq during the Gulf War sustained shrapnel injuries on the right side of his body from an ordinance explosion. He was rendered unconscious and taken to a field hospital where he underwent exploratory laparotomy and open arthrotomy to repair a right knee injury. He was later transferred to Germany and then back to the United States.

He was seen for headaches that had started several months after his injury. The headaches were described by the patient as "being hit in the right eye region." The frequency of the headaches was highly variable, from none to 3 times a week. They were severe enough to interfere with reading and driving but not other activities. He had no neurologic deficits. Psychiatric evaluation and neuropsychologic testing indicated the patient was functioning at his preinjury level.

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Computed tomographic scans showing trajectory pathway. A, Several hyperintense objects are present in the right frontal lobe (arrows). B, Shrapnel fragment at the junction of the left frontal lobe and the inner table of the skull (arrow). C, Bone windows revealing only the shrapnel fragment (arrow).

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Paul JT. Souvenir From War. Arch Neurol. 2000;57(7):1073. doi:10.1001/archneur.57.7.1073.

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