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Cook R, Zima L, Khazaal J, Williams J. Low-velocity penetrating brain injury: a review of the literature and illustrative case. Brain Inj 2024; 38:668-674. [PMID: 38555515 DOI: 10.1080/02699052.2024.2336067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied. CASE As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness. DISCUSSION Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course. CONCLUSION In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes.
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Affiliation(s)
- Richard Cook
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura Zima
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jawad Khazaal
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John Williams
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ota K, Kobata H, Tomonishi S, Ota K, Takasu A. Self-inflicted very-low-velocity penetrating head injury: A CARE-compliant case report. Medicine (Baltimore) 2024; 103:e37896. [PMID: 38701288 PMCID: PMC11062694 DOI: 10.1097/md.0000000000037896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/22/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE Low-velocity penetrating head injury (PHI) is rare, comprising 0.2% to 0.4% of head traumas, but can be devastating and is associated with significant morbidity and mortality. No previous case of very-low-velocity PHI due to self-inflicted stabbing with a gimlet has been reported. PATIENT CONCERNS A 62-year-old man was admitted to the hospital with bleeding head and abdominal wounds after stabbing his abdomen with a gimlet, and then hammering the same gimlet into his forehead and removing the gimlet himself. DIAGNOSES Upon examination at admission, stab wounds were present on the forehead and the right upper quadrant. Computed tomography (CT) of the head revealed a bone defect in the left frontal bone and showed the intracranial path of the gimlet surrounded by mild hemorrhage and pneumocephalus. Magnetic resonance imaging (MRI) confirmed a small amount of hemorrhage with pneumocephalus but no vascular injury. INTERVENTIONS Conservative treatment without surgery. OUTCOMES Follow-up MRI on hospital day 58 showed no abscess or traumatic intracranial aneurysm. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 69. LESSONS Very-low-velocity PHI might be successfully treated with conservative treatment.
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Affiliation(s)
- Koshi Ota
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Hitoshi Kobata
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Shunsuke Tomonishi
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kanna Ota
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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Assoumane II, Agada NK, Maman Sani R, Kélani A. Penetrating Head Injury by a Hit of Rake in a Child: A Case Report and Literature Review. Case Rep Neurol Med 2023; 2023:9921985. [PMID: 38025302 PMCID: PMC10676273 DOI: 10.1155/2023/9921985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries. Several nonmissile materials inserting the skull have been reported. But to our knowledge, never before has any case of PHI caused by a hit of rake been reported. We report a first case of PHI caused by a rake in a child; then, we relate our experience with its management and discuss the relevant literature. Cases Description. A 5-year-old boy has been admitted with a rake embedded in his head. That occurred during a violent play with a neighbor. At presentation, the child was alert; there was no neurological deficit. The rake was embedded in the parietal regions on each side of the midline. The head Computed Tomography (CT) scan performed showed a biparietal hyperdensity from either side of the midline with a metal artifact. In the operating room, after a transversal incision joining the 2 tips of the object, we performed successively bone flaps; object extraction; debridement; duraplasty; and closing. The outcome was uneventful. Conclusion This is the first case of PHI by a rake. The surgical management constitutes the main challenging point.
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Affiliation(s)
- Issa Ibrahim Assoumane
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
| | - Nicaise Kpègnon Agada
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
| | - Rabiou Maman Sani
- Zinder National Hospital, Zinder, Niger
- Faculty of Health Sciences of University of Zinder, Zinder, Niger
| | - Aminath Kélani
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
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Ullah Z, Ur Rehman M, Akbar A, Tasneem S, Jadoon SK. Unidentified Intracranial Foreign Body in an Epileptic Child: Infanticide or Child Abuse? Cureus 2023; 15:e47167. [PMID: 38022250 PMCID: PMC10652028 DOI: 10.7759/cureus.47167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Although intracranial foreign bodies are typically associated with penetrating injuries or surgical interventions, they can also occur as a result of rare instances of child abuse. Enduring such abuse and neglect as an infant can lead to life-long neurological problems, developmental delays, and impairments. The present case involved a 14-year-old male adolescent who was brought to the emergency room due to recurrent generalized tonic seizures. A computed tomography (CT) scan revealed a ring-like metallic object within the right temporal lobe. The neurosurgeon declined the surgical removal of the object due to its position and orientation, as well as the patient's guardian's refusal to consent to surgery. Instead, drug treatment and care are advised. In infants, foreign objects are typically inserted through cranial sutures, fontanelles and less frequently into the orbits, often with the intention of harming unwanted children. However, no history of such an attempt is present in this case. The incidental discovery of intracranial foreign bodies typically occurs during investigations when patients present with neurological symptoms such as epileptic seizures (foreign body-induced epilepsy). The selection of an ideal treatment regimen is often challenging in such cases. If a patient can be effectively treated with drugs, surgical removal is usually avoided.
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Affiliation(s)
| | | | - Amna Akbar
- Emergency and Accident, District Headquarter Jehlum, Muzaffarabad, PAK
| | - Sabhat Tasneem
- Public Health Sciences, Health Services Academy, Islamabad, PAK
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Takao K, Matsuta H, Murata K, Fujiki M. Reversible cerebral vasospasm and cerebral infarction secondary to meningitis following penetrating head trauma with bamboo. BMJ Case Rep 2023; 16:e254676. [PMID: 37553171 PMCID: PMC10414058 DOI: 10.1136/bcr-2023-254676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
A man in the 70s fell on a bamboo and punctured his left upper eyelid. CT of the head showed fractures of the medial and superior walls of the left orbit, intracranial traumatic subarachnoid haemorrhage, intraventricular haematoma and left frontal cerebral contusion. He was treated conservatively. Despite prophylactic antibiotic therapy, he had prolonged loss of consciousness. A cerebrospinal fluid examination revealed bacterial meningitis. Imaging studies on day 15 showed extensive subacute cerebral infarction in the bilateral parieto-occipital lobes and main trunk artery stenosis. On day 31, MRA showed improvement of the main arteries, and cerebral vasospasm-induced cerebral infarction was diagnosed. He was transferred to rehabilitation with full assistance. The prognosis of bamboo perforation trauma is critical. Thus, preventing and treating central nervous system infection are considered the key to the prognosis. However, given the lack of established treatment for meningitis-associated cerebral vasospasm, case-specific treatment must be considered.
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Affiliation(s)
- Kunpei Takao
- Department of Neurosurgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroyuki Matsuta
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Kumi Murata
- Department of Forensic Medicine, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
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Abdulsada AM, Ismail M, Elsayed AM, Emara MR, Al-Khazaali YM, Albairmani SS, Muthana A, Hoz SS. Stephanion to cranial base penetrating stab wound with outstanding recovery: A case report. Surg Neurol Int 2023; 14:72. [PMID: 36895221 PMCID: PMC9990633 DOI: 10.25259/sni_962_2022] [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: 10/19/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023] Open
Abstract
Background Mortality due to head trauma is common in developed countries in all age groups. Nonmissile penetrating skull base injuries (PSBIs) due to foreign bodies are quite rare, accounting for about 0.4%. PSBI carries that a poor prognosis brainstem involvement usually is often fatal. We are reporting the first case of PSBI with a foreign body insertion site through the stephanion with a remarkable outcome. Case Description The 38-year-old male patient was referred with a penetrating stab wound to the head through the stephanion caused by a knife after a conflict in the street. He had no focal neurological deficit or cerebrospinal fluid leak, and Glasgow coma scale (GCS) was 15/15 on admission. A preoperative computed tomography scan showed the path of the stab beginning at the stephanion, which is the point where the coronal suture crosses the superior temporal line, heading toward the cranial base. Postoperatively, GCS was 15/15 without any deficit apart from the left wrist drop, possibly due to a left arm stab. Conclusion Careful investigations and diagnoses must be made to ensure convenient knowledge of the case due to the variety of injury mechanisms, foreign body characteristics, and individual patients' characteristics. Reported cases of PSBIs in adults have not reported a stephanion skull base injury. Although brain stem involvement is usually fatal, our patient had a remarkable outcome.
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Affiliation(s)
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mohamed R Emara
- University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | - Younus M Al-Khazaali
- Department of Neurosurgery, University of Al-Nahrain, College of Medicine, Baghdad, Iraq
| | - Sama S Albairmani
- Department of Neurosurgery, University of Al-Iraqia, College of Medicine, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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Tse MF, Huang SH, Tsai YH, Li CH. Non-missile penetrating brain injury-surgical techniques for removing a long penetrating foreign body: a case report. Br J Neurosurg 2022:1-4. [PMID: 36583395 DOI: 10.1080/02688697.2022.2159926] [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: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Penetrating brain injury (PBI), a relatively uncommon injury, is associated with remarkable secondary complications such as vascular injury, intracranial haemorrhage, infection, and mortality. Non-missile PBI (NMPBI) due to sharp or blunt objects is usually treated surgically by removing the penetrating object, evacuating the associated haemorrhage, identifying possible bleeders along with haemostasis, and performing debridement. Various approaches are used for different scenarios of non-missile PBI according to the object's characteristics, penetrating site, depth, associated intracerebral haemorrhage (ICH), and presence of vascular injury along the penetrating tract. NMPBI cases are rarely reported among civilians. We herein describe a patient who was successfully treated for NMPBI, as well as frontal ICH, by simultaneously removing the heavy, metallic penetrating foreign body. METHODS We performed corticotomy through a shorter tract instead of a deep penetrating trajectory, which minimizes the extent of damage to the brain and enables immediate management of vascular injury under direct vision while removing the foreign body, and intraoperative sonography, which provides real-time information of the penetrating object and the surrounding brain structure. We did not perform computed tomography angiography and digital subtraction angiography (DSA) because the stab location was at the frontal region, with low risk of vascular injury. Moreover, DSA is time-consuming, which may delay decompressive surgery. RESULTS The patient was successfully treated through an alternative approach removing the long, heavy, metallic penetrating foreign body and eliminating the accompanying frontal ICH simultaneously. Focal brain abscess developed 8 days after the injury and resolved completely after antibiotics treatment. Dysphasia gradually improved but right distal limbs weakness with spasticity is still present. CONCLUSIONS Our findings suggest prompt diagnosis by preoperative imaging, screening of vascular injury, decompression with debridement, and antibiotics treatment are important. The alternative surgical approach we proposed is exceptional and should be considered while treating patients with deep NMPBI.
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Affiliation(s)
- Ming-Fai Tse
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Shih-Hao Huang
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Yi-Hsin Tsai
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chien-Hsun Li
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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Torche Velez E, Rojas Vilarroel P, Vera Figueroa F, Vigueras Alvarez S. Transorbital penetrating intracranial injury, with cavernous sinus involvement. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:377-382. [PMID: 35248505 DOI: 10.1016/j.neucie.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/29/2021] [Accepted: 08/20/2021] [Indexed: 06/14/2023]
Abstract
Transorbitary intracranial penetrating traumatic injuries are uncommon in the paediatric population, and may occur in the context of domestic, sporting or school accidents. They can extend to skull base and compromise vascular structures such as cavernous sinus and internal carotid. We present a case of 6 years-old girl that suffered an intracranial transorbital penetrating injury with a wooden pencil that crossed from the medial edge of left orbit, transetmoidal and trans-sphenoidal, entering the right sellar region and leaving its end in contact with carotid artery (cavernous segment). After pre-surgical studies, foreign body removal was performed with endoscopic surgery + endovascular control in case of carotid injury. After removing the foreign body, a CSF fistula occurred and was repaired. Patient recovered adequately, without neurological deficit, without postoperative CSF fistula, without CNS infection or oculomotor alteration.
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Affiliation(s)
- Esteban Torche Velez
- Hospital Guillermo Grant Benavente (Hospital Regional de Concepción), Concepción, Chile
| | - Pablo Rojas Vilarroel
- Hospital Guillermo Grant Benavente (Hospital Regional de Concepción), Concepción, Chile
| | - Franco Vera Figueroa
- Hospital Guillermo Grant Benavente (Hospital Regional de Concepción), Concepción, Chile.
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Yousif RS, Omar AM, Ismail M, Hamouda WO, Alkhafaji AO, Hoz SS. Excellent recovery after nonmissile penetrating traumatic brain injury in a child: A case report. Surg Neurol Int 2022; 13:388. [PMID: 36128089 PMCID: PMC9479510 DOI: 10.25259/sni_350_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury. Case Description: We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull base zone. Conclusion: We demonstrated that following standard recommendations in the management of pTBI which include applying the advanced trauma life support protocol in ER, acquiring the needed preoperative neuroimaging studies, avoiding moving the penetrating object till patient shifted to OR, and finally performing a planned stepwise surgical intervention through craniotomy may yield an excellent functional recovery, especially in children despite an otherwise grave initial presentation and apparently profound brain injury.
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Affiliation(s)
- Reber S. Yousif
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Alend M. Omar
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Mustafa Ismail
- College of Medicine, University of Baghdad, Baghdad, Iraq,
| | - Waeel O. Hamouda
- Department of Neurosurgery, Kasr Alainy School of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt,
- Department of Neurological and Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia,
| | | | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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Bujok J, Bobiński R, Dutka M, Ilczak T, Ulman-Włodarz I, Hajduga M, Pająk C. Open craniocerebral trauma in a patient at work: A case report. Work 2022; 72:989-995. [DOI: 10.3233/wor-205213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Craniocerebral injuries belong to the category of bodily injuries which are characterised by high mortality and a high percentage of permanent effects in the form of disability. The likelihood of this injury exists in the workplace too. Performing works at a height or using high-pressure or mechanical machinery exposes employees to a higher risk of a craniocerebral injury. CASE REPORT: This case study deals with the topic of open craniocerebral trauma suffered by a 20-year-old man who was wearing no head protection at his place of work. It details the management of this trauma at the site of the accident, during transfer to the hospital and during hospitalisation. CONCLUSION: Fast transport, effective diagnostics and implementation of surgical treatment contributed to a good final result.
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Affiliation(s)
- Jan Bujok
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
- Department of Neurosurgery, Provincial Hospital in Bielsko-Biała, Bielsko-Biała, Poland
| | - Rafał Bobiński
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Mieczysław Dutka
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Izabela Ulman-Włodarz
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Maciej Hajduga
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Celina Pająk
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
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Hoey A, Troy C, Bauerle W, Xia A, Hoey B. Delayed-Onset Seizures Following Self-Inflicted Nail Gun Injury to the Head: A Case Report and Literature Review. J Neurol Surg Rep 2022; 83:e54-e62. [PMID: 35756905 PMCID: PMC9232295 DOI: 10.1055/s-0042-1749650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Nail gun use and its associated incidence of injury have continued to increase since it was first introduced in 1959. While most of these injuries involve the extremities, a subset of patients suffer intracranial trauma. The most recent comprehensive review on this particular subject referenced 41 cases and advocated for further discussion regarding proper treatment plans for these individuals. We present the case of a 25-year-old who suffered 35 self-inflicted penetrating head wounds from a nail gun after suffering an amputation injury at his job site. No neurological deficits were present on his arrival to the emergency room. He underwent surgery to treat his arm wound and remove 13 of the 35 nails. The patient was discharged from the hospital on levetiracetam and made a full recovery. Nearly 1 year later, he experienced a seizure at his workplace. However, after resuming his antiepileptic medication, he reports no further complications. This case is distinct for not only being the most nails in a patient's head at presentation, but also following surgery. Utilizing this case, prior review, and 27 subsequent cases, we propose an updated algorithm for diagnosis and treatment of nail-gun-related penetrating head trauma.
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Affiliation(s)
- Alexander Hoey
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Christopher Troy
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Wayne Bauerle
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Anthony Xia
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Brian Hoey
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
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12
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Alnufaili SS, Althobaiti NM, Almuhaimeed SS. A Metal Badge Embedded in the Forehead: A Case Report of Military Uniform Safety. Cureus 2021; 13:e20168. [PMID: 34881133 PMCID: PMC8643395 DOI: 10.7759/cureus.20168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/05/2022] Open
Abstract
Foreign body (FB) injury to the head is not uncommon in medical practice. Various objects have been reported in penetrating head injuries. Depth and location of penetration determine the expected complications and management approach. Here, we describe a case of FB injury to the head by the metal badge of a uniform hat and discuss the medical implications of such injuries among a large population of workers at risk. A 23-year-old male presented to the emergency room with the metal badge of his uniform hat embedded in the left side of his forehead after a physical altercation at work. Imaging revealed FB penetrating the soft tissue and minimally embedded in the outer table of the left frontal bone. The FB was removed in the emergency room with no complications. The wound was then cleaned and sutured, and the patient was discharged home with oral antibiotics for one week. Penetrating FB to the head can present significant morbidity to military personnel, and thus a safer design of work uniforms is warranted.
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Daulay ER. Unusual Case of Low-Velocity Large Object Penetrating the Frontal Bone with Favorable Outcome: A Case Report in Pediatric Patient. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Penetrating head injury is one of the deadliest forms of head trauma; the outcome is usually low, and patients who survive long enough require complex medical treatment. Immediate imaging assessment with appropriate management can improve patient recovery.
CASE REPORT: We reported a case of head penetration trauma on a 12-year-old child with embedded cylindrical iron that enters the skull without any signs of neurological deficit.
CONCLUSIONS: This case shows that aggressive diagnostic imaging and emergency care followed by proper immediate head surgery management and postoperative intensive care to monitor and intervene in possible surgical and medical complications could significantly improve patient outcomes.
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Torche Velez E, Rojas Vilarroel P, Vera Figueroa F, Vigueras Alvarez S. Lesión penetrante intracraneana transorbitaria, con compromiso de seno cavernoso en paciente pediátrico. Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A Rare Case of Craniocervical Penetrating Injury by a Steel Bar. J Craniofac Surg 2021; 33:e365-e368. [PMID: 34694764 DOI: 10.1097/scs.0000000000008194] [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
Rationale Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery. Chief Complaint The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability. Diagnosis Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue. Intervention We successfully performed the operation and removed the steel bar. Outcomes The patient was followed up for 5 years; muscle strength returned to normal. Lessons Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.
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Oearsakul T, Kaewborisutsakul A, Jantharapattana K, Khumtong R, Puetpaiboon A, Sangthong B. Multidisciplinary management of a penetrating cerebellar injury by a fishing speargun: A case study and literature review. Surg Neurol Int 2021; 12:391. [PMID: 34513157 PMCID: PMC8422459 DOI: 10.25259/sni_506_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Fishing spearguns are a rare cause of nonmissile penetrating brain injuries (PBIs). Discussion of their injury patterns and treatments has been published only sporadically. Here, we report a case of a self-inflicted PBI caused by this type of weapon and present an extensive review of previous case reports to help ascertain the appropriate surgical approach. Case Description: A 26-year-old man with a preexisting psychiatric illness was transferred to our hospital after a self-inflicted shot with a fishing speargun through his mouth. The ensuing injuries included the impalement of a spear intracranially through the soft palate and posterior oropharyngeal wall. The spear was surgically accessed by the otolaryngology team by splitting the soft palate and was removed by the neurosurgery team in the retrograde direction. Cerebral angiographies were done pre- and postoperatively, and these did not detect any vertebrobasilar arterial system injuries. The patient’s postoperative care was uneventful, and he was followed up by a psychiatrist for his long-term care. Conclusion: This example of a complicated case of nonmissile PBI caused by an uncommon type of weapon shows how this type of medical emergency can be managed successfully with effective teamwork using a multidisciplinary approach.
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Affiliation(s)
- Thakul Oearsakul
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Kitti Jantharapattana
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Rujimas Khumtong
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Asamaporn Puetpaiboon
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Burapat Sangthong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
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Yu SDPM, Lau JSK, Chau YM, Kan PG. Fencing unmasked: A case of penetrating cranio-orbital injury. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907919855158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Transorbital low-velocity penetrating head injuries are uncommon but important. Minor skin wounds may herald intracranial injury with high morbidity and mortality. Case presentation: A fencing coach was pierced by a sabre between his nose and right eye resulting in orbital roof fracture and frontal lobe laceration. With prompt recognition of these injuries under multidisciplinary management, he attained uncomplicated recovery. Conclusion: The emergency physician should maintain a high index of suspicion for intracranial injury in patients presenting with history of penetrating head injury. Understanding orbital anatomy, injury mechanisms and patterns can facilitate timely management to prevent potentially sight-threatening and life-threatening complications.
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Affiliation(s)
| | - James Siu Ki Lau
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Yau Ming Chau
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Pui Gay Kan
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
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Harrington BM, Gretschel A, Lombard C, Lonser RR, Vlok AJ. Complications, outcomes, and management strategies of non-missile penetrating head injuries. J Neurosurg 2020; 134:1658-1666. [PMID: 32559744 DOI: 10.3171/2020.4.jns20122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While high-velocity missile injury (gunshot) is associated with kinetic and thermal injuries, non-missile penetrating head injury (NMPHI) results in primary damage along the tract of the piercing object that can be associated with significant secondary complications. Despite the unique physical properties of NMPHI, factors associated with complications, expected outcomes, and optimal management have not been defined. In this study, the authors attempted to define those factors. METHODS Consecutive adult patients with NMPHI who presented to Tygerberg Academic Hospital (Cape Town, South Africa) in the period from August 1, 2011, through July 31, 2018, were enrolled in a prospective study using a defined treatment algorithm. Clinical, imaging, and laboratory data were analyzed. RESULTS One hundred ninety-two patients (185 males [96%], 7 females [4%]) with 192 NMPHIs were included in this analysis. The mean age at injury was 26.2 ± 1.1 years (range 18-58 years). Thirty-four patients (18%) presented with the weapon in situ. Seventy-one patients (37%) presented with a Glasgow Coma Scale (GCS) score of 15. Weapons included a knife (156 patients [81%]), screwdriver (18 [9%]), nail gun (1 [0.5%]), garden fork (1 [0.5%]), barbeque fork (1 [0.5%]), and unknown (15 [8%]). The most common wound locations were temporal (74 [39%]), frontal (65 [34%]), and parietal (30 [16%]). The most common secondary complications were vascular injury (37 patients [19%]) and infection (27 patients [14%]). Vascular injury was significantly associated with imaging evidence of deep subarachnoid hemorrhage and an injury tract crossing vascular territory (p ≤ 0.05). Infection was associated with delayed referral (> 24 hours), lack of prophylactic antibiotic administration, and weapon in situ (p ≤ 0.05). A poorer outcome was associated with a stab depth > 50 mm, a weapon removed by the assailant, vascular injury, and eloquent brain involvement (p ≤ 0.05). Nineteen patients (10%) died from their injuries. The Glasgow Outcome Scale (GOS) score was linearly related to the admission GCS score (p < 0.001). One hundred forty patients (73%) had a GOS score of 4 or better at discharge. CONCLUSIONS The most common NMPHI secondary complications are vascular injury and infection, which are associated with specific NMPHI imaging and clinical features. Identifying these features and using a systematic management paradigm can effectively treat the primary injury, as well as diagnose and manage NMPHI-related complications, leading to a good outcome in the majority of patients.
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Affiliation(s)
| | | | - Carl Lombard
- 2Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Western Cape, South Africa; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adriaan J Vlok
- 1Division of Neurosurgery, University of Stellenbosch; and
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Savitri QM, Putri CP, Gunawan KJ, Hapsari DL, Sidharta I, Wicaksono P. Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report. Int J Surg Case Rep 2020; 72:85-90. [PMID: 32531706 PMCID: PMC7289748 DOI: 10.1016/j.ijscr.2020.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023] Open
Abstract
Penetrating Brain Injury (PBI) incidence rate is lower than other type of head traumas, but it's the most hazardous one. Non enchanced head CT (NECT) is beneficially helpful for the surgeons to construct surgical plan and to estimate the prognosis related to patient's condition. Brain abscess is commonly found as PBI complication, it can appear 2–4 weeks, in some cases may delayed to 2–3 months after the time of injury. The broad-spectrum prophylactic antibiotics is important to control the infection, though abscess formation may be inevitable.
Introduction Brain abscess is a compilation of pus enclosed in capsule as a result of focal infection in brain parenchyma. It is one of several complications found in patients who suffered penetrating brain injury. Case presentation Thirty-four-year-old man suffered a penetrating brain injury after a 50 cm piece of wood penetrated through his facial skull and ended its tip in his cerebellum, the wood priorly ejected from a moulding machine. As a consequence, he had to undergo a craniotomy procedure to remove the foreign body object and its debris. Following the surgery, adequate antibiotics were administered. Postoperative enhanced head CT revealed a cystic mass formation in the left hemisphere of cerebellum, measured 20 × 28 mm with blood density lesions and a visible ring enhancement. These features suggested a cerebellar abscess. The follow-up enhanced head CT later demonstrated that the size, shape, and location of the abscess were relatively consistent with the previous head CT. Discussion Penetrating brain injury (PBI) is the most life-threatening head trauma. Although the prevalence number was low compared to other head traumas, its morbidity and mortality number were higher. Brain abscess formation is one of the many PBI complications. Due to direct inoculation of foreign body and its debris, PBI commonly leads an infection process. However, the infection process is supposed to be overcome by administering broad-spectrum antibiotics prophylactically. This case presented an inevitable brain abscess despite of the adequate antibiotics administration. Conclusion Despite adequate antibiotics has been administered, cerebellar abscess after penetrating brain injury is still found challenging to manage. Therefore, holistic-multidisciplinary approaches are needed.
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Affiliation(s)
| | | | | | | | - Iwan Sidharta
- Department of Surgery, Semen Gresik Hospital, Gresik, Indonesia
| | - Pandu Wicaksono
- Department of Surgery, Semen Gresik Hospital, Gresik, Indonesia
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Young M, Putty M, Finneran MM, Johnson R, Schaible K, Farhat H. Multidisciplinary Management of Low-velocity Nonmissile Penetrating Head Injuries. Cureus 2020; 12:e7388. [PMID: 32337115 PMCID: PMC7179989 DOI: 10.7759/cureus.7388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Penetrating head injuries (PHIs) can have diverse presentations and mechanisms; therefore, treatment methods have not been clearly outlined. Vascular injury is common and foreign body removal is often required. We present three cases to illustrate low-velocity nonmissile penetrating head injuries (NPHIs) and discuss a multidisciplinary approach. Methods We present a case series from our institution that illustrates the importance of multidisciplinary treatment of these injuries. All injuries are low- velocity NPHIs with separate mechanisms and anatomical locations. Results Multidisciplinary management involving neurosurgery, otolaryngology, and neuroendovascular surgery is represented in our case series with all patients having good clinical outcomes. Our first case is a 34-year-old male who presented neurologically intact after a stabbing in the left temporal region with concerns for external carotid artery injury and maxillary sinus injury. Our second case is a 37-year-old male who presented with a self-inflicted nail gun injury that penetrated the right temporal bone, right temporal lobe, bilateral sphenoid sinus, and left petrous carotid canal with concerns of petrous internal carotid injury. Our third case is a 31-year-old male who presented after an accidental nail gun injury that penetrated through the oral cavity, hard palate, and left sphenoid sinus and ending in the left cavernous sinus with concerns of cavernous internal carotid injury. Conclusion Careful consideration must be taken when evaluating low-velocity NPHIs. Particular attention must be given when an associated vascular injury is suspected. Our case series highlights the importance of a multidisciplinary approach in achieving good clinical outcomes in PHIs.
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Affiliation(s)
- Michael Young
- Neurological Surgery, Advocate Health Care, Oak Lawn, USA
| | - Matthew Putty
- Neurological Surgery, Advocate Health Care, Normal, USA
| | - Megan M Finneran
- Neurological Surgery, Advocate BroMenn Medical Center, Normal, USA
| | - Ryan Johnson
- Neurological Surgery, Advocate BroMenn Medical Center, Normal, USA
| | - Keith Schaible
- Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, USA
| | - Hamad Farhat
- Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, USA
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MacLean MA, Mukhida K, Shankar JJS, Schmidt MH, Clarke DB. Complete recovery following transorbital penetrating head injury traversing the brainstem: case report. J Neurosurg Pediatr 2019; 24:697-701. [PMID: 31491753 DOI: 10.3171/2019.6.peds19106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
Transorbital penetration accounts for one-quarter of the penetrating head injuries (PHIs) in adults and half of those in children. Injuries that traverse (with complete penetration of) the brainstem are often fatal, with survivors rarely seen in clinical practice. Here, the authors describe the case of a 16-year-old male who suffered and recovered from an accidental transorbital PHI traversing the brainstem-the first case of complete neurological recovery following such injury. Neuroimaging captured the trajectory of the initial injury. A delayed-onset carotid cavernous fistula and the subsequent development of internal carotid artery pseudoaneurysms were managed by endovascular embolization.The authors also review the relevant literature. Sixteen cases of imaging-confirmed PHI traversing the brainstem have been reported, 14 involving the pons and 12 penetrating via the transorbital route. Management and outcome of PHI are informed by object velocity, material, entry point, trajectory, relationship to neurovascular structures, and the presence of a retained foreign body. Trauma resuscitation is followed by a careful neurological examination and appropriate neuroimaging. Ophthalmological examination is performed if transorbital penetration is suspected, as injuries may be occult; the potential for neurovascular complications highlights the value of angiography. The featured case shows that complete recovery is possible following injury that traverses the brainstem.
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Affiliation(s)
- Mark A MacLean
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Karim Mukhida
- 2Dalhousie University, Department of Anesthesia, Pain Management & Perioperative Medicine, Halifax, Nova Scotia
| | - Jai J S Shankar
- 3Department of Medicine, Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba; and
| | - Matthias H Schmidt
- 4Dalhousie University, Division of Diagnostic Radiology, Department of Diagnostic Radiology, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - David B Clarke
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
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Li Z, Chen J, Qu X, Duan L, Huang C, Zhang D, Hou L. Management of a Steel Bar Injury Penetrating the Head and Neck: A Case Report and Review of the Literature. World Neurosurg 2018; 123:168-173. [PMID: 30447445 DOI: 10.1016/j.wneu.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nonmissile penetrating injuries to the head and neck caused by a steel bar are rare, and a standard management strategy is lacking. CASE DESCRIPTION A 42-year-old woman sustained a steel bar injury with penetration of the head and neck. Computed tomography and three-dimensional reconstruction were performed for preoperative evaluation. Digital subtraction angiography was performed to confirm potential vascular injury. The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team. CONCLUSIONS Relevant literature regarding nonmissile penetrating injuries involving a steel bar was reviewed to propose appropriate management strategies. Comprehensive imaging evaluation and prompt surgery by a multidisciplinary team contributed to the successful removal of the steel bar.
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Affiliation(s)
- Zhenxing Li
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jigang Chen
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolin Qu
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liwei Duan
- Department of Emergency, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenguang Huang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danfeng Zhang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Lan Z, Richard SA, Ma L, Yang C. Nonmissile Anterior Skull-Base Penetrating Brain Injury: Experience with 22 Patients. Asian J Neurosurg 2018; 13:742-748. [PMID: 30283537 PMCID: PMC6159019 DOI: 10.4103/ajns.ajns_36_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Nonmissile anterior skull-base penetrating brain injuries (NASBPBIs) have specific characteristic features that are different from missile injuries. Our study presents our experiences on the characteristic features as well as management of NASBPBI. Materials and Methods: We retrospectively reviewed 22 consecutive patients with NASBPBI managed at our institute during a 13-year period. The mechanism of injury, clinical investigations, and complications were analyzed, with more emphasis on diagnostic and treatment regimen. Results: The 22 cases included in our study comprise of 20 males and 2 females. Majority (72.7%) of the patients were adults with a mean age of 27.5 years. The mechanisms of injury often include accidental fall, either onto a small-diameter sharp object (10 cases) or while carrying such an object in the hand (4 cases). The other common mechanisms were stabbing, accident, or during an altercation (8 cases). Clinical manifestations included periorbital hematoma (10 cases, 45.5%) and cerebrospinal fluid rhinorrhea or orbitorrhea (4 cases, 18.2%) as well as signs of embedded foreign object (8 cases, 36.4%). We performed emergency craniotomy in 21 cases and skin debridement in one case. Postoperative complications were abscess (1 case), epilepsy (1 case), and traumatic carotid-cavernous fistula (1 case). Conclusion: Nonmissile injuries are generally on the rise and therefore deserve more attention. We observed that clinical outcomes were excellent in 14 (Glasgow Outcome Scale [GOS] score of 5) and good in the remaining 8 patients (GOS of 4) during 6-month–10-year (mean 4.6 years) follow-ups.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Immunology, Jiangsu University, Zhenjiang, Jiangsu, China.,Department of Surgery, Volta Regional Hospital, Ho, Ghana-West Africa
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaohua Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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A Case of Impalement Brain Injury That Could Achieve Good Neurological Outcome by Introducing Early Sedation and Immobilization Strategy. Case Rep Emerg Med 2018; 2018:3025717. [PMID: 29805816 PMCID: PMC5899847 DOI: 10.1155/2018/3025717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/22/2018] [Indexed: 11/17/2022] Open
Abstract
Impalement brain injury is rare, and the initial management of this condition is not well-established. We present a case of a well-managed brain injury caused by impalement with a metal bar. A 29-year-old man whose head had been impaled by a metal bar was transferred to our hospital. Upon arrival, he was agitated, with an unsteady gait and prominent odor of alcohol on his breath. He exhibited normal vital signs and neurological findings, except for his level of consciousness. To address the risk of secondary brain injury caused by movement of the foreign body, we immediately administered a sedative agent and muscle relaxant after the initial neurological evaluation. The imaging evaluation revealed the insertion of a metal bar into the right frontal lobe at a depth of >100 mm through the frontal bone; however, there was no apparent major vessel injury-related complication. Three hours after arrival at the hospital, a craniotomy was performed to remove the foreign body. The patient's postoperative course was uneventful, and he was discharged after rehabilitation without any neurological deficits. The strategy of immediate immobilization to prevent the secondary brain injury is important in the initial management of a patient who has survived an impalement brain injury and presented to an emergency department.
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Drosos E, Giakoumettis D, Blionas A, Mitsios A, Sfakianos G, Themistocleous M. Pediatric Nonmissile Penetrating Head Injury: Case Series and Literature Review. World Neurosurg 2018; 110:193-205. [DOI: 10.1016/j.wneu.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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