Intracranial injuries by a screwdriver

Determining the manner of death in victims in drug-induced psychosis: a case of an atypical head stab wound

This case report presents a rare case of an atypical head stab wound suffered by a drug addict and inflicted with a screwdriver during drug-induced psychosis. It describes the diagnostic and treatment procedures in the hospital and the findings of the subsequent autopsy. It also analyzes the review of the interpretation of the CT scans made upon admission and the subsequent treatment by an independent medical review panel, which revealed signs of medical mismanagement. Therefore, it also discusses the legal consequences that the case may have involved for the attending physicians in addition to the consequences for the suspected perpetrator. The report raises many issues encountered in the case in terms of the clinical treatment and forensic determination of the manner of death in cases of injuries caused by sharp instruments and highlights the importance of comprehensive evaluation of the circumstantial evidence together with the clinical or autopsy findings, since such evidence may sometimes be overlooked in clinical practice.

Brown-Sequard syndrome associated with a spinal cord injury caused by a retained screwdriver: A case report and literature review

Background:

Nonmissile penetrating spine injury (NMPSI) represents a small percent of spinal cord injuries (SCIs), estimated at 0.8% in Western countries. Regarding the causes, an NMPSI injury caused by a screwdriver is rare. This study reports a case of a retained double-headed screwdriver in a 37-year-old man who sustained a stab injury to the back of the neck, leaving the patient with a C4 Brown-Sequard syndrome (BSS). We discuss the intricacies of the surgical management of such cases with a literature review.

Methods:

PubMed database was searched by the following combined formula of medical subjects headings, (MESH) terms, and keywords: (((SCIs [MeSH Terms]) OR (nmpsi [Other Term]) OR (nonmissile penetrating spinal injury [Other Term]) OR (nonmissile penetrating spinal injury [Other Term])) AND (BSS [MeSH Terms])) OR (BSS [MeSH Terms]).

Results:

A total of 338 results were found; 258 were case reports. After excluding nonrelated cases, 16 cases were found of BSS induced by spinal cord injury by a retained object. The male-to-female ratio in these cases is 11:5, and ages ranged from 11 to 72. The causes of spinal cord injury included screwdrivers in three cases, knives in five cases, and glass in three cases. The extracted data were analyzed.

Conclusion:

Screwdriver stabs causing cervical SCIs are extremely rare. This is the first case from Iraq where the assault device is retained in situ at the time of presentation. Such cases should be managed immediately to carefully withdraw the object under direct vision and prevent further neurological deterioration.

Penetrierende Schädelverletzungen mit elektrischen Bohrmaschinen – ungewöhnliche Verletzungsmuster

Zwei außergewöhnliche Fälle von fremdbeigebrachten penetrierenden Kopfverletzungen durch elektrische Bohrmaschinen werden präsentiert. Derartige Abläufe stellen als Tötungsdelikt bzw. versuchtes Tötungsdelikt eine extreme Rarität dar. Wenige Beschreibungen betreffen Suizide, Suizidversuche oder unfallbedingte Verletzungen durch Bohrmaschinen. Im Fall eines 47 Jahre alten Mannes wurde dem Opfer von seiner in Scheidung lebenden Exfrau mit einer ausgeschalteten Bohrmaschine im Schlaf durch das Ohr in den Schädel gestochen. Der Mann überlebte den Angriff. In dem anderen Fall kam es zu einer Auseinandersetzung zwischen zwei jungen Männern, wobei der Beschuldigte seinem Opfer zunächst Messerstiche und anschließend Bohrerverletzungen zufügte. Insgesamt konnten autoptisch drei durch das Auge in das Schädelinnere eindringende Bohrkanäle festgestellt werden. Das Opfer verstarb unmittelbar am Geschehensort.

Traumatic Brain Injury Due to Screwdriver Assaults: Literature Review and Case Report

Penetrating head injuries due to the use of screwdrivers as wounding agents in acts of interpersonal violence seldom occur. The aim of this article is to update and summarize the relevant literature on penetrating craniocerebral screwdriver stab wounds and to report a new case of screwdriver assault. A number of studies were reviewed to investigate the incidence, distribution, common findings, mechanism of injury, differential diagnostic criteria, complications, treatment, and prognosis of craniocerebral screwdriver stab injuries. It was observed that the degree of traumatic severity depends on the cross-sectional area of the screwdriver and the anatomical region of injury. Craniocerebral screwdriver injuries are mainly cases of interpersonal violence and the mortality rate is approximately 47.6%. In 23.8% of the incidents, the trauma is overlooked on admission because of the small entry wound and, thus, the severity of the injury is not initially appreciated.

Intracranial penetrating injury by screw driver: a case report and review of literature

Penetrating injury to the head, with the exception of missile injuries is rare owing to thick calvarium. Orbital and temporal areas are comparatively vulnerable to penetrating injuries, due to their relative thinness. A case is presented in which a man killed his wife by forcefully thrusting a screw driver into her cranial cavity. The deceased presented to the hospital with the screw driver embedded in her head. She was declared as 'brought dead on arrival' at the emergency of the hospital. Pre-autopsy plain radiography and Computed Tomography (CT) of the head were done to assess the extent of brain damage. The peculiarity of this case lies in the fact that screw driver as a stabbing weapon in the head is very rarely used. In such cases, there is a need to perform radiography and CT with the weapon in-situ for better interpretation on injuries. In this paper role of radiography and CT in intra cranial penetration is discussed with review of literature.

Perforating brain injury from a speargun. A case report

A case of a perforating brain injury caused by a speargun in a suicide attempt is described. Although this kind of injuries has been previously reported, the present case is specially interesting because the patient showed no neurological deficit after surgery. Some advices about the medical and surgical management are proposed based on this case and our literature review. The use of antibiotics and antiepileptic drugs and the anterograde extraction of the harpoon aided by the performance of a craniotomy surrounding the exit point are recommended.

A stab in the back with a screwdriver: a case report

Background

Stabbings infrequently produce spinal injury. However, the use weapons other than blades can overcome this natural defence barrier.

Case Presentation

We present a spinal injury produced by a screwdriver, its management and a review of the literature.

Conclusion

This case highlights the need for clinical vigilance, including in those who appear stable and a senior multidisciplinary approach to each individual case.

Macroscopic characteristics of screwdriver trauma

The main objective of the study was to determine the type of macroscopic trauma created by a flat-tipped and a cross-tipped screwdriver. The second objective was to determine if the trauma inflicted by the two screwdrivers could be macroscopically differentiated. Three tests were conducted, each by a male volunteer. Each test consisted of 12 samples of fleshed pig ribs; six were stabbed with a flat-tipped screwdriver and the remaining six with a cross-tipped screwdriver (Phillips). Each sample received 15 stab wounds during the process. The stabbings were conducted at perpendicular and oblique angles, with fabric variables being utilized. Results illustrate two main categories of macroscopic skeletal trauma, fractures, and puncture wounds. By studying the macroscopic appearance in tandem with differing trauma frequencies, these two screwdriver types can be differentiated.

Analysis of experimental cranial skin wounding from screwdriver trauma

As part of a more extensive investigation of skin wounding mechanisms, we studied wounds created by five common screwdrivers (straight, star, square or Robertson, Posidriv and Phillips) on the shaven foreheads of 12 freshly slaughtered pigs. We fixed the different screwdriver heads to a 5-kg metal cylinder which was directed vertically onto each pig head by a droptube of 700 mm length. We examined skin lesions by photography and also by scanning electron microscopy (SEM). Our evaluation of differences in wound shape and size was based on geometric morphometric methods. Our results show that there are obvious morphological differences between the straight head and the other types. The straight-headed screwdriver penetrates the skin by a mode II crack which results in a compressed skin plug with bundles of collagen fibres forming skin tabs within the actual wound. The sharper-tipped screwdrivers wedge open the skin (mode I), with a clearly defined edge with no skin plugs. Geometric morphometric analysis indicates that shapes of skin wounds created by the five screwdriver types could be classified into three different groups. The straight head results in the most differentiated wound profile, with the Robertson or square and some specimens of star, and also the Posidriv and Phillips giving similar wound outlines. SEM evaluation of wounds created by a new and worn straight-head screwdrivers shows that the outline of the worn screwdriver head is reflected in the shape of the wound it created.

Emergency surgery in a severe penetrating skull base injury by a screwdriver: case report and literature review

Background

Very few cases of severe penetrating injuries to the skull base with a seemingly innocuous object have been described in the literature. Of the cases reported, only ten involve a penetrating screwdriver. However, the choice of therapeutic management, whether it be emergency surgical or non-surgical removal of the penetrating object as well as the selected surgical approach remain quite controversial.

Case presentation

The authors describe the case of a severe penetrating skull base injury caused by a screwdriver, following an accidental fall from a ladder. The patient was admitted in Glasgow Coma Scale (GCS) 11 with a cerebrospinal fluid (CSF) leak in the right maxillary area. The tri-dimensional computerized tomography (3-D CT) scan revealed an oblique trajectory of the screwdriver shank through the skull base. The authors opted for an emergency surgical extraction of the object. A contra-lateral pterional approach was successfully performed and a two-year follow-up showed no neurological deficits.

Conclusion

The reported case supports the choice of emergency surgical removal of the object in penetrating skull base injuries involving the anterior skull base with neurovascular lesions. Surgical aspects of the pterional approach, and in particular the left pterional approach as well as other cranio-facial approaches in severe penetrating skull base injuries are discussed.

[Penetrating head injury from harpoon. Case report]

The harpoon presence as aggressor weapon is unusual in the neurosurgical practice. Most cases are associated with diving or sport activities as result of imprudence. A 31 year old patient who sustained a penetrating craniocerebral injury with a fishing harpoon is presented and complementary exams, neurosurgical procedure and postoperative evolution are detailed. We discuss the management of this unusual injury and review the current literature on craniocerebral injuries caused by similar objects.

Penetrating intracranial wooden object: case report and review of CT morphology, complications, and management

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.

Transorbital penetrating brain injury caused by a toy arrow: a case report

A case of a 9-year-old boy with a transorbital toy-arrow injury to the brain is presented. At admission he was in coma (Glasgow Coma Scale of 6) with right hemiparesis and had a completely prolapsed left eye. Computerized tomography revealed intracranial haemorrhage and fracture of the orbital wall, which were treated conservatively. His left eye was enucleated due to massive injury. At the 6-month check-up the boy still show neurological signs of latent right hemiparesis. Disturbances, mostly cognitive, were noted on his psychological tests. A survey of the literature reveals no report of this nature in the paediatric age group. The necessity of continuous monitoring of new environmental risks as they occur, and the requirement for the prevention of recreational brain injuries in children, is stressed.

Homicide with a screwdriver and simulation of a similar offence by self-infliction of injuries

In an underground garage of a department store, a 52-year-old woman was attacked and fatally wounded by several stabs with a screwdriver. The offence happened as the woman was getting into her car. The homicide itself and the subsequent trial were extensively covered in the local media. A few days before the judgement was pronounced, another attack in an underground garage was reported to the police of the town, where the homicide had happened. A 52-year-old woman claimed to have been hurt by an assailant. The wound pattern (several equally shallow cuts arranged in groups), however, suggested self-infliction, which was finally admitted by the informant. The 'victim' used a newly bought kitchen knife to cut herself and left it at the place of the alleged assault. The knife blade was soiled with blood. Referring to the pertinent literature both cases are compared with regard to the injury characteristics and to the damage to the clothing. The morphological features of screwdriver injuries, the criteria differentiating self-infliction and assault as well as the manifestation of copycat offences are discussed.