WIDESPREAD AXONAL INJURY IN GUNSHOT WOUNDS TO THE HEAD USING AMYLOID PRECURSOR PROTEIN AS A MARKER

In order to determine whether axonal injury (AI) is a factor in cases of penetrating head injury, the brains of 14 patients who died shortly after sustaining a fatal gunshot wound (GSW) to the head were examine d, and the presence of AI determined using immunohistochemical stainin g for amyloid precursor protein (APP), The distribution of AI was mapp ed throughout the cerebral hemispheres and brain stem. AI was present in all cases in a diffuse distribution distant to the missle track wit h severe involvement of the brain stem in all cases. There was no axon al APP immunoreactivity in the direct region of the missle track at th e point of primary axotomy, The APP-positive AI in these cases is like ly to be a mixture of primary and secondary AI as APP immunostaining i s unable to distinguish primary AI due to mechanical deformation from AI secondary to hypoxic-ischemic damage.