Profuse hemorrhage from cerebral vessels in tangential missile injuries

Tangential missile injuries are recognized as a cause of cerebral damage by in driven bone fragments, parenchymal lacerations and intracerebral haematomas. Severe blood loss from this type of injury was not reported. Four patients are described in whom high kinetic energy missiles caused severe tangential craniocerebral injuries. Their condition was aggravated by life threatening haemorrhage. The bleeding vessels were cerebral arteries or major veins entrapped in the fracture line and bleeding extracranially. This blood loss cannot be controlled by dressing and salvage could be achieved only by immediate resuscitation, vigorous fluid replacement and very rapid evacuation to a neurosurgical center.