• Samer S Hoz, Zaid S Aljuboori, Ali A Dolachee, Zahraa F Al-Sharshahi, Mohammed A Alrawi, and Ammar M Al-Smaysim.
• Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.
• World Neurosurg. 2020 Jun 1; 138: e119-e123.

BackgroundSince their advent in the 1920s, tear gas canisters (TGCs) have been frequently used in crowd control. Few reports have documented nonpenetrating injuries attributed directly to TGCs. In this study, we report a case series of fatal penetrating head injuries caused by TGCs.MethodsWe conducted a retrospective chart review of all the patients who were admitted to the Neurosurgery Teaching Hospital in Baghdad, Iraq, since the start of the antigovernment protests (October 2019). All patients who suffered penetrating head trauma caused by TGCs were included in our study. We collected patient demographics, wound location, neurologic examination, computed tomography (CT) scan findings, surgical management, and clinical outcomes.ResultsWe found 10 cases of penetrating head trauma caused by TGCs. All victims were men, with a mean age of 16 years (range, 14-19 years). The mean Glasgow Coma Scale score was 7 (range, 3-10). The neurologic examination revealed unilateral hemiplegia/hemiparesis and pupillary abnormality in 40% (n = 4) and 50% (n = 5) of the patients, respectively. CT scans revealed an extensive pattern of brain damage. Surgical intervention was done in 80% of cases (n = 8), which included removal of the TGC, wound debridement, and hemostasis. The in-hospital mortality rate was 100% (N = 10), with all fatalities occurring within 1-3 days of admission.ConclusionsTGCs have the potential to cause lethal penetrating head injuries, calling for a reevaluation of their safety and methods of use in terms of human health.Copyright © 2020 Elsevier Inc. All rights reserved.

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