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CONCLUSIONS
The patient in this case was large and obese.
The bullet from the entry wound to the left lung penetrated through
14 cm of fatty tissue.
Because fat has little strength and its volume in this case was large,
it is likely that the temporary cavity caused by penetration
of the bullet was very large.
The cavity acted like a large body moving along with the bullet,
and together they generated the pressure disturbance that propagated
toward the spine,
and caused injury to the spinal cord,
primarily on the left side.
The larger cavity would cause
a stronger pressure wave to be generated.
Patients with a more well-knit musculature and with less volume into which the
cavity could expand, would tend to be relatively better
protected from the development of high-intensity effects remote
from the bullet path.
The absence of (?? symptoms) usually associated with
classic Brown-Séquard syndrome in this case
may be attributed to the fact that no lesion precisely transected
or injured a hemisection
of the cord and there was no bony injury to the vertebra
(Saxon).
It has been pointed out[17]
that this is theoretically possible in gunshot wound to the spinal
cord (Grant).
This case has once again demonstrated that
when there is no apparent injury to the spinal cord,
it may be difficult to diagnose spinal cord injury.
brad@galcit.caltech.edu