Multiple cranial gunshot injuries without skull penetration

We report on a 74 year old patient who was admitted to the Emergency Department of Cologne University after an attempt to commit suicide. Clinical examination showed no neurological deficits but two bleeding bullet holes in his head bilateral in the temporal areas initially suggesting a complete passage of a bullet through the head. The patient was able to answer questions but showed also a slight bleeding from his mouth while talking. Emergency CT showed a bullet between the internal and external lamina of the temporal bone on both sides and one bullet in the hard palate. With general anesthesia, all bullets were removed without complications, the wounds were sutured and general antibiotics were administered. The patient survived without neurological deficit and antidepressants were commenced. Examination of the gun revealed a Second World-War 7.65 mm Luger handgun with degenerated gun powder quality and humidity after 50 years storage in the patient s bedroom.