Delayed focal seizures following gunshot wound to the head in a child with minimal initial sequelae

Abstract

A 6 year old girl accidentally discovered a gun in her home and shot herself in her mouth. A bullet lodged in her right frontal lobe, but she remained neurologically intact with minimal symptoms. Her diagnosis was delayed due to the family leaving the emergency room for long wait times and later noticed over 72 hours from the injury at a dentist appointment. She was sent back to the emergency department, where head imaging revealed the injury to be inoperable. Six months later, the patient developed focal impaired awareness seizures. This was treated with oxcarbazepine, and patient responded well with no further spells. The case was highly unusual as the neurological symptoms were mild compared to the severity and the risk of initial intracranial injury. It emphasizes the frequently overlooked risk of leaving guns unsecured in households with children.