Complete recovery and resolution of neurological symptoms following a penetrating gunshot in the left frontal lobe: a case report

BACKGROUND: Traumatic brain injury is a major global health concern, with penetrating brain trauma representing an uncommon but highly lethal subset, especially in conflict-affected regions. Outcomes in penetrating brain trauma are strongly influenced by admission Glasgow Coma Scale (GCS), extent of structural injury, projectile characteristics, and imaging findings. Early expert assessment, rapid neuroimaging, and timely surgical intervention are critical for improving survival in selected patients although long‑term recovery often requires multidisciplinary rehabilitation. We report a rare case of penetrating brain trauma in a 14‑year‑old male who achieved complete neurological recovery following prompt and appropriate management. CASE PRESENTATION: A 14‑year‑old Syrian male presented with a penetrating gunshot injury to the left frontal region, arriving with a GCS of 10, left pupillary non-reactivity, periorbital ecchymosis, cerebrospinal fluid leak, and a depressed comminuted frontal fracture. Computed tomography imaging revealed multiple bone fragments penetrating the left frontal lobe, an anterior skull base fracture, pneumocephalus, contusions, and a bullet lodged in the right maxillary sinus. He underwent urgent left frontal craniectomy with removal of bone fragments, dural repair, and abdominal preservation of the bone flap. Postoperatively, his neurological status improved rapidly to a GCS of 15 within 12 h, with spontaneous resolution of cerebrospinal fluid leakage. The patient remained neurologically intact and was discharged with plans for subsequent neuropsychological follow-up and cranioplasty (refer to Graphical Abstract). CONCLUSION: This case highlights the importance of rapid assessment and timely intervention in penetrating brain trauma despite its high morbidity and mortality. The patient's full recovery from an initial GCS of 10 underscores the value of appropriate rehabilitation. Accurate projectile identification and avoidance of management delays are essential, and multidisciplinary collaboration may benefit selected cases.