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Cucu AI, Costea CF, Silișteanu SC, Blaj LA, Istrate AC, Patrascu RE, Hartie VL, Patrascanu E, Turliuc MD, Turliuc S, Sava A, Boişteanu O. Repetitive Self-Inflicted Craniocerebral Injury in a Patient with Antisocial Personality Disorder. Diagnostics (Basel) 2024; 14:1549. [PMID: 39061686 PMCID: PMC11276516 DOI: 10.3390/diagnostics14141549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. Computed tomography each time revealed the presence of a metal foreign body (screw, nail, metal rod, and wire) passing through the frontal bone into the frontal lobe. In each situation, the foreign body was safely extracted with a favorable outcome. Despite the use of the latest imaging modalities, metal artifacts can limit the assessment of vascular involvement, and special attention must be given to preoperative planning. Surgical extraction of the foreign body can be safely performed when appropriate preoperative planning is carried out to consider all possible complications.
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Affiliation(s)
- Andrei Ionut Cucu
- Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania;
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
| | - Claudia Florida Costea
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Ophthalmology, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Sînziana Călina Silișteanu
- Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania;
| | - Laurentiu Andrei Blaj
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Neurosurgery, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Ana Cristina Istrate
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
| | - Raluca Elena Patrascu
- National Institute for Infectious Diseases Prof. Dr. Matei Bals, 021105 Bucharest, Romania;
- Infectious Diseases Department, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Vlad Liviu Hartie
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
| | - Emilia Patrascanu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Mihaela Dana Turliuc
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Neurosurgery, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Serban Turliuc
- Department of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iaşi, Romania;
| | - Anca Sava
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Morpho-Functional Sciences I, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iași, Romania
| | - Otilia Boişteanu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
- Sf. Spiridon County Clinical Emergency Hospital Iași, 700111 Iași, Romania
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Lin LY, Lefebvre DR. Orbital Penetrating Injuries: A Review on Evaluation and Management. Int Ophthalmol Clin 2024; 64:11-29. [PMID: 38525979 DOI: 10.1097/iio.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Stepwise Reconstruction of a Large, Self-Inflicted Calvarial Defect. J Craniofac Surg 2021; 33:1116-1117. [PMID: 34560747 DOI: 10.1097/scs.0000000000008192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Scalp expansion ensures that tissue similar in color, texture, thickness, and most importantly, hair-bearing quality, is available to resurface the scalp. It is a critical option for reconstruction of large calvarial defects. CLINICAL PRESENTATION Over 6 months, a 55-year-old male patient excoriated his scalp into a full-thickness scalp and calvarial wound resulting in dural violation and meningitis. The patient presented with altered mental status and methicillin-susceptible staphylococcus aureus (MSSA) bacteremia, cranial osteomyelitis, and an intracranial abscess secondary to the large scalp defect. The patient underwent immediate debridement and dural coverage with a scalp rotational flap. Several months later he began delayed stepwise cranioplasty with multiple scalp tissue expanders given the deficiency of soft tissue. CONCLUSIONS This case is presented to highlight the unusual mechanism of injury and the complex reconstructive approach in surgical management.
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Dávila Siliezar PA, Duarte-Celada WR, Montalvan V, Duarte-Celada C, Aguilar Ruiz BE. Self-inflicted transorbital pontine stab injury with a retained pen. Proc (Bayl Univ Med Cent) 2021; 34:323-324. [DOI: 10.1080/08998280.2020.1854038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | | | - Victor Montalvan
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | | | - Basilio E. Aguilar Ruiz
- Department of Neurosurgery, University of San Carlos de Guatemala, Guatemala City, Guatemala
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Kanu LN, Liu CY, Oh DJ, MacIntosh PW, Setabutr P. Self-insertion of foreign bodies into the orbit and periocular tissue. Orbit 2018; 38:486-491. [PMID: 30570433 DOI: 10.1080/01676830.2018.1556705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe six patients with 12 separate episodes of self-inflicted periocular foreign body injuries, which presented to our institution recently. All patients were male, relatively young (mean 28.5 years old), incarcerated, and had significant underlying psychiatric conditions. The subjects had inserted staples (6), paperclips (2), or other small metallic wire segments (4) into the periocular region. Most cases (9/12) involved concurrent self-inflicted injury to other body parts. Ten cases involved foreign bodies inserted through the palpebral conjunctiva into the upper eyelid, while two cases involved insertion into the orbit. Identification and surgical retrieval of foreign bodies was successful in most cases (9/11) but was not attempted in one case. Self-inflicted periocular injuries, while rare, are challenging cases for which the ophthalmologist should be prepared. A multidisciplinary approach, including psychiatric assessment and treatment, is important for optimal care.
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Affiliation(s)
- Levi N Kanu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Catherine Y Liu
- Shiley Eye Institute, University of California San Diego , San Diego , California , USA
| | - Daniel J Oh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Peter W MacIntosh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Pete Setabutr
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago , Illinois , USA
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Bolatkale M, Acara AC. The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury. Am J Emerg Med 2018; 37:433-438. [PMID: 29887193 DOI: 10.1016/j.ajem.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%-93% and 87%-100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. METHODS The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB. RESULTS The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p < .001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with ≤2 (p < .001). A statistically significant negative correlation was determined between GCS and number FB (r = -0.697; p < .001). CONCLUSION When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI.
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Affiliation(s)
- Mustafa Bolatkale
- Medipol University Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Ahmet Cagdas Acara
- Bozyaka Research and Training Hospital, Department of Emergency Medicine, Izmir, Turkey
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Management of Penetrating Skull Base Injury: A Single Institutional Experience and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2838167. [PMID: 28828384 PMCID: PMC5554568 DOI: 10.1155/2017/2838167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/18/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Penetrating skull base injury (PSBI) is uncommon among head injuries, presenting unique diagnostic and therapeutic challenges. Although many cases of PSBIs have been reported, comprehensive understanding of its initial diagnosis, management, and outcome is still unavailable. MATERIALS AND METHODS A retrospective review was performed for patients treated in neurosurgical department of Changzheng Hospital for PSBIs. Presurgical three-dimensional (3D) Slicer-assisted reconstructions were conducted for each patient. Then we reviewed previous literature about all the published cases of PSBIs worldwide and discussed their common features. RESULTS A total of 5 patients suffering PSBIs were identified. Penetrating points as well as the surrounding neurovascular structures were clearly visualized, assisting in the presurgical planning of optimal surgical approach and avoiding unexpected vascular injury. Four patients underwent craniotomy with foreign bodies removed successfully and 1 patient received conservative treatment. All of them presented good outcomes after proper management. CONCLUSION Careful physical examination and radiological evaluation are essential before operation, and angiography is recommended for those with suspected vascular injuries. 3D modeling with 3D Slicer is practicable and reliable, facilitating the diagnosis and presurgical planning. Treatment decision should be made upon the comprehensive evaluation of patient's clinicoradiological features and characteristics of foreign bodies.
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Riley JP, Boucher AB, Kim DS, Barrow DL, Reynolds MR. The Role of Intraoperative Cerebral Angiography in Transorbital Intracranial Penetrating Trauma: A Case Report and Literature Review. World Neurosurg 2017; 97:761.e5-761.e10. [DOI: 10.1016/j.wneu.2016.09.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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Mzimbiri JM, Li J, Bajawi MA, Lan S, Chen F, Liu J. Orbitocranial Low-Velocity Penetrating Injury: A Personal Experience, Case Series, Review of the literature, and Proposed Management Plan. World Neurosurg 2016; 87:26-34. [DOI: 10.1016/j.wneu.2015.12.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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Kodadek LM, Leeper WR, Caplan JM, Molina C, Stevens KA, Colby GP. Retained transcranial knife blade with transection of the internal carotid artery treated by staged endovascular and surgical therapy: technical case report. Neurosurgery 2015; 11 Suppl 2:E372-5; discussion E375. [PMID: 25714518 DOI: 10.1227/neu.0000000000000691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE We describe the use of proximal and distal endovascular coil embolization of the internal carotid artery followed by operative removal of a retained foreign object transecting the petrocavernous portion of the internal carotid artery. CLINICAL PRESENTATION A 20-year-old man sustained a stab wound to the left temporal skull and presented with a retained knife blade. He reported a headache at presentation, but remained neurologically intact with a Glasgow Coma Scale of 15. Computed tomography imaging and subsequent angiography confirmed complete transection of the petrocavernous segment of the left internal carotid artery with effective tamponade by the knife blade in situ and satisfactory collateral flow across the Circle of Willis. Coil embolization of the left internal carotid artery was performed. Retrograde embolization of the petrocavernous internal carotid segment distal to the injury was performed via vertebral and posterior communicating artery access. Antegrade embolization of the internal carotid artery proximal to the injury was completed and the patient was transferred to the operating room for craniectomy and foreign body extraction. Postoperative computed tomography angiography revealed no parenchymal hemorrhage, mass effect, or midline shift, and successful embolization of the internal carotid artery. At 6-week follow-up, the patient remained neurologically intact with no infectious or vascular complications. CONCLUSION Staged endovascular and surgical therapy provides complete assessment and effective control of damaged vessels when retained intracranial foreign bodies are present. Given the high risk of vascular injury with retained transcranial foreign bodies, this strategy should be considered a safe approach for these challenging cases.
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Affiliation(s)
- Lisa M Kodadek
- *Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; ‡Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Jeon YH, Kim DM, Kim SH, Kim SW. Serious penetrating craniocerebral injury caused by a nail gun. J Korean Neurosurg Soc 2014; 56:537-9. [PMID: 25628820 PMCID: PMC4303736 DOI: 10.3340/jkns.2014.56.6.537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/10/2014] [Accepted: 02/01/2014] [Indexed: 11/29/2022] Open
Abstract
Penetrating cerebral injuries caused by foreign bodies occur rarely due to the substantial mechanical protection offered by the skull. Throughout most of history, the brain, residing in a "closed box" of bone, has not been vulnerable to external aggression. Recently, we encountered a serious penetrating craniocerebral injury caused by a nail gun. Total excision of the offending nail via emergency craniotomy was performed, but the patient's neurologic status was not improved in spite of aggressive rehabilitative treatment. Here, we report on this troublesome case in light of a review of the relevant literature.
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Affiliation(s)
- Yong Hyun Jeon
- Department of Anatomy, College of Medicine, Chosun University, Gwangju, Korea
| | - Dong Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Instantaneous death due to transorbital reverse penetration of a screw in an accidental fall: unusual autopsy case report and review of the literature. Am J Forensic Med Pathol 2014; 35:15-9. [PMID: 24457588 DOI: 10.1097/paf.0000000000000079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board. A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as "reverse penetration." The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere. These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury. The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit. Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident. To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical. The case is now under discussion, and a review of pertinent literature is performed.
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Skoch J, Ansay TL, Lemole GM. Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush. J Neurol Surg Rep 2013; 74:23-8. [PMID: 23943716 PMCID: PMC3713554 DOI: 10.1055/s-0033-1346976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022] Open
Abstract
Objectives Intracranial penetration by foreign bodies entering via the orbit represent an unusual form of traumatic brain injury. Nevertheless, much is at stake with high risk for cranial nerve and neurovascular injury. We present a case where the bristled end of a toothbrush entered the brain as a projectile via the superior orbital fissure and discuss considerations for surgical management. Setting A 35-year-old woman suffered a periorbital injury after her husband threw an electric toothbrush at a wall and the head of the toothbrush became a missile that projected through her superior orbital fissure and into her right temporal lobe. She complained of headache and incomplete vision loss in the affected eye. Intervention After obtaining a cerebrovascular angiogram, we proceeded with emergent orbital decompression and anterograde extraction of the foreign body via a modified frontotemporal orbitozygomatic approach with drilling of the skull base allowing for en bloc removal of the toothbrush. Conclusions The patient recovered well with improvement in her vision and partial third and sixth nerve palsies. This report illustrates a unique mechanism of injury with a novel intracranial foreign body. We review the neurosurgeon's need for prompt management with an approach customized to the structure of the offending object, the damaged elements, and the surrounding cranial nerves and vascular anatomy.
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Affiliation(s)
- Jesse Skoch
- Division of Neurosurgery, University Medical Center, University of Arizona, Tucson, Arizona, USA
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An unusual case of attempted suicide by a depressive woman: Self-inflicted intracranial stabbing. Forensic Sci Int 2013; 226:e9-11. [DOI: 10.1016/j.forsciint.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 08/08/2012] [Accepted: 12/02/2012] [Indexed: 11/18/2022]
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Abstract
While self-mutilations with stab wounds are relatively common in psychiatric patients suffering from schizophrenia and personality disorders, they are rarely performed as suicidal attempts. Even in psychotic patients, suicidal stab wounds of the skull are rare in the literature. We report the case of a 34-year-old schizophrenic man whom emergency medical services (EMS) providers cared for at his home because of a complete self-amputation of his right hand, without any other apparent wound than a facial laceration. The patient was transferred to the acute surgical ward for evaluation of the possibility reimplantation of the amputated hand. When his neurologic status rapidly declined after hospital admission, a whole-body computed tomography (CT) scan was performed for other injuries. Unexpectedly, cerebral CT scan showed the presence of an intracranial 11-cm-long blade, whose distal tip was located in the left temporal cerebral lobe. Given the nature of the cerebral injuries on CT scan and the major impairment of the neurologic status of the patient, the neurosurgeon considered surgical extraction of the blade to be futile, and the patient's condition rapidly deteriorated to brain death.
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Affiliation(s)
- Benoît Vivien
- SAMU de Paris, Département d'Anesthésie-Réanimation, Hôpital Necker, Enfants Malades, Université Paris Descartes, Paris, France.
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Abstract
Oro-cranial penetrating injuries are often seen in ear, nose and throat practices. Cases of penetrated pencil injuries are rarely reported despite being common in the developing world. A 7-year-old boy referred from a neighboring hospital was playing at school with the sharp end of a pencil in his mouth when he was pushed from behind by another child. He fell on his face and the sharp end of the pencil penetrated his throat with the distal end hanging out. There was no bleeding at presentation, as the pencil completely sealed the entrance point. The entrance point was at the posterior wall of the oropharynx corresponding to the uvulo-palatine junction. It penetrated posterosuperiorly through the soft tissue to reach the anterior part of the posterior cranial fossa. Since sharp and pointed objects in the upper aerodigestive tract can result in potentially fatal complications, prompt diagnosis, a systematic treatment protocol, and an experienced trauma team are necessary to prevent a potential catastrophe.
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Affiliation(s)
- Shuaib K Aremu
- Department of Ear, Nose and Throat, Ibrahim Babangida Specialized Hospital, Minna, Niger State, Nigeria.
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Abstract
BACKGROUND Little is known about the psychiatric state of patients who stab themselves in the brain (intracranial self-stabbing), including whether the behavior is usually an attempt to commit suicide and whether it is performed in association with symptoms of psychotic illness. METHOD A search for cases of intracranial self-stabbing in New South Wales, Australia (NSW), and a systematic search for published case reports of intracranial self-stabbing. RESULTS We located 5 cases in NSW in the last 10 years and 47 published case reports of intracranial self-stabbing since 1960. Intracranial self-stabbing was associated with a diagnosis of a psychotic illness in 27 of 49 (55%) cases in which a diagnosis was available. Intracranial self-stabbing was not always performed with the intention of committing suicide and does not usually have a fatal outcome. CONCLUSIONS Intracranial self-stabbing appears to be an under-recognized form of self-harm that is associated with, but not limited to, psychotic illness.
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Lee JI, Ko JK, Cha SH, Han IH. An unusual case of cerebral penetrating injury by a driven bone fragment secondary to blunt head trauma. J Korean Neurosurg Soc 2012; 50:532-4. [PMID: 22323943 DOI: 10.3340/jkns.2011.50.6.532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/14/2011] [Accepted: 12/05/2011] [Indexed: 11/27/2022] Open
Abstract
Temple trauma that appears initially localized to the skin might possess intracranial complications. Early diagnosis and management of such complications are important, to avoid neurologic sequelae. Non-penetrating head injuries with intracranial hemorrhage caused by a driven bone fragment are extremely rare. A 53-year-old male was referred to our hospital because of intracerebral hemorrhage. He was a mechanic and one day before admission to a local clinic, tip of metallic rod hit his right temple while cutting the rod. Initial brain computed tomography (CT) and magnetic resonance imaging demonstrated scanty subdural hematoma at right temporal lobe and left falx and intracerebral hematoma at both frontal lobes. Facial CT with 3-D reconstruction images showed a small bony defect at the right sphenoid bone's greater wing and a small bone fragment at the left frontal lobe, crossing the falx. We present the unusual case of a temple trauma patient in whom a sphenoid bone fragment migrated from its origin upward, to the contralateral frontal lobe, producing hematoma along its trajectory.
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Affiliation(s)
- Jae Il Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Schreckinger M, Orringer D, Thompson BG, La Marca F, Sagher O. Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm. J Neurosurg 2011; 114:53-61. [DOI: 10.3171/2010.8.jns10301] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transorbital penetrating injury (TPI), an uncommon subset of head trauma, requires prompt multidisciplinary surgical intervention. While numerous case reports appear in the literature, there is a lack of discrete recommendations for initial evaluation, surgical intervention, and postoperative care of patients with TPI.
A retrospective review of 4 cases of TPI at the University of Michigan Health System was undertaken to assess for diagnosis, treatment, and follow-up. In addition, a PubMed search using the terms “penetrating orbital trauma,” “penetrating orbital injury,” “transorbital penetration,” and “transorbital penetrating injury” were used to search for articles discussing the presentation and management of penetrating orbital trauma.
All 4 of the patients at the University of Michigan underwent focused physical examination performed by a multidisciplinary trauma team followed by dedicated maxillofacial and head CT scanning. The patients' treatments varied, depending on the mechanism and extent of the injury. An analysis of the case series presented here as well as other published cases suggests an algorithm for diagnosis and treatment for patients with TPI, which includes focused evaluation, diagnostic imaging with maxillofacial CT scanning, and management of the injury that focuses on the path of penetration and the presence of the foreign body in situ at the time of presentation. Magnetic resonance imaging is indicated in patients who have indwelling wooden foreign bodies. Angiography should be performed in patients with suspected vascular injury. Treatment decisions should be made by a multidisciplinary team with input from neurosurgery, ophthalmology, otolaryngology, and maxillofacial surgery.
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Affiliation(s)
| | - Daniel Orringer
- 2Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Frank La Marca
- 2Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Oren Sagher
- 2Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
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Self-inflicted orbital and intracranial pencil. J Emerg Med 2010; 43:490-1. [PMID: 20566258 DOI: 10.1016/j.jemermed.2010.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 02/10/2010] [Accepted: 05/02/2010] [Indexed: 11/20/2022]
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Bhaganagare A, Nadkarni T, Goel A. Penetrating craniocerebral injury with nails: Case report. INDIAN JOURNAL OF NEUROTRAUMA 2007. [DOI: 10.1016/s0973-0508(07)80016-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Turbin RE, Maxwell DN, Langer PD, Frohman LP, Hubbi B, Wolansky L, Mori M. Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases. Surv Ophthalmol 2006; 51:449-60. [PMID: 16950246 DOI: 10.1016/j.survophthal.2006.06.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present an illustrative case of occult transorbital penetrating intracranial injury in a child, and review the literature concerning patterns of low-velocity, non-projectile injury during the era of modern CT and MRI study. Review of the mechanism of injury and analysis of surface entry site of penetration in 38 cases suggests recurring patterns of injury in occult and non-occult cases. A classification system based on surface entry zone site is applied to these injuries. Knowledge of the classification system should increase clinical suspicion for this type of often occult, penetrating orbito-cranial injury and direct appropriate investigation to provide earlier detection and diagnosis of the transorbital, intracranial penetration.
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Affiliation(s)
- Roger E Turbin
- Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry-New Jersey Medical School, Newark, New Jersey 07103, USA.
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Chibbaro S, Tacconi L. Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients. Acta Neurochir (Wien) 2006; 148:937-41; discussion 941-2. [PMID: 16763734 DOI: 10.1007/s00701-006-0794-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature. METHOD We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours. FINDINGS Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4. CONCLUSION The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Brain Abscess/etiology
- Brain Abscess/surgery
- Brain Injuries/diagnosis
- Brain Injuries/etiology
- Brain Injuries/physiopathology
- Cerebral Hemorrhage, Traumatic/etiology
- Cerebral Hemorrhage, Traumatic/surgery
- Cranial Fossa, Anterior/diagnostic imaging
- Cranial Fossa, Anterior/injuries
- Cranial Fossa, Anterior/pathology
- Diagnosis, Differential
- Early Diagnosis
- Eye Infections/etiology
- Eye Infections/prevention & control
- Female
- Foreign Bodies/complications
- Foreign Bodies/diagnosis
- Foreign Bodies/physiopathology
- Frontal Bone/diagnostic imaging
- Frontal Bone/injuries
- Frontal Bone/pathology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnosis
- Head Injuries, Penetrating/physiopathology
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neurosurgical Procedures/methods
- Neurosurgical Procedures/standards
- Orbital Fractures/complications
- Orbital Fractures/diagnosis
- Orbital Fractures/physiopathology
- Predictive Value of Tests
- Retrospective Studies
- Tomography, X-Ray Computed
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Trieste University Hospital, Trieste, Italy.
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25
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Abstract
Foreign bodies in the esophagus are commonly seen in otolaryngologic practice. We report the successful removal of a working wrist watch dial lodged for one month in the esophagus of an adult schizophrenic patient, which is a rare incident.
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26
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Cunningham EJ, Albani B, Masaryk TJ, Rasmussen PA. Temporary balloon occlusion of the cavernous carotid artery for removal of an orbital and intracranial foreign body: case report. Neurosurgery 2005; 55:1225. [PMID: 15791741 DOI: 10.1227/01.neu.0000140991.82075.01] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1-V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.
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Affiliation(s)
- Edwin J Cunningham
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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27
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28
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Abstract
Upon necroscopic examination of a homeless male found comatose in the street and pronounced dead at a medical center 12 hours later, a sharp tip of a knife lodged in the right parietal region of his skull was incidentally discovered. The blade transected the diploe and penetrated the cerebral cortex. Subsequent police investigation revealed that this was the remnant of a stabbing attempt on his life several months prior to his death. The cause of death was determined to be unrelated to the metallic blade fragment, thus making it a truly incidental and rare finding of a "souvenir knife." Nevertheless, since the injury sustained in the stabbing was potentially life threatening, the investigation into that assault was reopened.A case report is presented, along with a brief review of the literature on "souvenir objects."
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Affiliation(s)
- Neil L Davis
- National Center of Forensic Medicine, Tel Aviv, Israel
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29
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Strub WM, Weiss KL. Self-inflicted transorbital and intracranial injury from eyeglasses. Emerg Radiol 2003; 10:109-11. [PMID: 15290520 DOI: 10.1007/s10140-003-0296-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2003] [Accepted: 05/03/2003] [Indexed: 10/26/2022]
Abstract
Orbital injuries are commonly seen in the emergency department, and if they are high-energy they can lead to concomitant intracranial injuries. Plain films, CT, MRI, and ultrasound are used in various combinations to evaluate the extent of these injuries. We describe a unique case of self-inflicted transorbital penetrating intracranial injury from the temporal wire rim of a pair of eyeglasses. Imaging well demonstrates the full course of the wire rim in situ, and pathoanatomic correlates are highlighted.
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Affiliation(s)
- William M Strub
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio 45267, USA
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30
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Abstract
Penetrating craniofacial injuries are rare especially in the pediatric age group. They are potentially life-threatening and challenging injuries. We describe an unusual trauma in a 30-month-old child who suffered a craniofacial injury caused by TV antenna. Clinical examination and radiological investigation showed the antenna penetrating the hard palate, left posterior nasal choana, sphenoid sinus, and skull base, up to pituitary fossa. There was no evidence of great vessels injury that confirmed by cerebral angiography. Transpalatal approach was used to remove the antenna and repair the skull base defect. There was no neurological or visual activity deficit postoperatively. The child developed diabetes insipidus that is well controlled using desmopressin.
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Affiliation(s)
- Khalid Al-Sebeih
- Department of Surgery-Otolaryngology Division, Faculty of Medicine, Kuwait University, PO Box 17228 khalidiya, 72453 Kuwait.
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31
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Bell NS, Amoroso PJ, Wegman DH, Senier L. Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers. Inj Prev 2001; 7:4-9. [PMID: 11289533 PMCID: PMC2254187 DOI: 10.1136/ip.7.1.4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Death rates among US veterans of the Persian Gulf War were lower than rates among non-deployed veterans and the US population at large, with the exception of injury deaths; returning veterans were at significantly greater risk of injury mortality. Similar patterns of excess injury mortality were documented among US and Australian veterans returning from Vietnam. In spite of these consistent findings little has been done to explain these associations and in particular to determine whether or not, and how, war related exposures influence injury risk among veterans returning home after deployments. HYPOTHESIZED PATHWAYS Several potential pathways are proposed through which injury might be related to deployment. First, increases in injury mortality may be a consequence of depression, post-traumatic stress disorder, and symptoms of other psychiatric conditions developed after the war. Second, physical and psychological traumas experienced during the war may result in the postwar adoption of "coping" behaviors that also increase injury risk (for example, heavy drinking). Third, greater injury risk may be the indirect consequence of increased experiences of ill defined diseases and symptoms reported by many returning veterans. Fourth, veterans may experience poorer survivability for a given injury event resulting in greater mortality but not morbidity. Finally, the process that selects certain individuals for deployment may lead to a spurious association between deployment status and injury mortality by preferentially selecting individuals who are risk takers and/or exposed to greater hazards. CONCLUSIONS More research and attention from policymakers is needed to clarify the link between deployment and postwar increased risk of injury.
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Affiliation(s)
- N S Bell
- Social Sectors Development Strategies, Inc, Natick, Massachusetts 01760-1041, USA.
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32
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Arunkumar MJ, Selvapandian S, Rajshekhar V. Penetrating intracranial wooden object: case report and review of CT morphology, complications, and management. SURGICAL NEUROLOGY 1999; 51:617-20. [PMID: 10369229 DOI: 10.1016/s0090-3019(99)00029-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Penetrating intracranial wooden fragments after vehicular accidents are uncommon. The CT morphology, complications, and management in such cases are quite variable. CASE REPORT A 27-year-old male was seen with a "twig" from a tree embedded firmly just below the right medial canthus after a motorcycle accident. Diagnosis of intracranial penetrating wooden object was made on CT scanning. The wooden stick, which had splintered into two, was extricated through a craniotomy in two operative sessions. However the patient succumbed to septicemia and meningitis on the twelfth day after the accident. CONCLUSIONS The need for prompt extrication of these objects and the causes of high mortality in this condition are discussed. The importance of imaging the intracranial compartment in injuries involving the periorbital region is emphasized.
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Affiliation(s)
- M J Arunkumar
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India
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Abstract
Penetrating injuries of the paranasal sinuses due to foreign bodies are rare, especially as a result of a traffic accident. Here we report a patient with a ballpoint pen lodged in his left eye following a traffic accident. The pen extended from the medial aspect of the left orbit, through the left ethmoid sinus and the nasal septum, to the right sphenoid sinus. We removed the pen uneventfully using endoscopic sinus surgery. There are no similar reports in the English literature and we therefore present this case because of its rarity.
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Affiliation(s)
- M R Wu
- Department of Otolaryngology, Taipei Municipal Jen-Ai Hospital, Taiwan
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Peschel O, Betz P, Eisenmenger W. Self-mutilation with needles. MEDICINE, SCIENCE, AND THE LAW 1997; 37:175-178. [PMID: 9149514 DOI: 10.1177/002580249703700215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Two cases of self-mutilation with needles are reported. One of the deceased suffered from chronic schizophrenia and committed suicide by plastic bag suffocation. At autopsy several needles were detected grown into the connective tissue of chest or abdominal organs. In the other case a knitting needle was used for repeated manipulations at the forehead leading to a defect of the skin and the skull. At least one vessel was injured leading to an extensive haemorrhage in the left hemisphere of the brain. The forensic and etiologic aspects of the cases are discussed.
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Affiliation(s)
- O Peschel
- Department of Legal Medicine, University of Munich, Germany
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