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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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Davis LE, Tripathi S. A Case of Self-Enucleation in an Incarcerated Patient: Case Report and Review of Literature. J Forensic Sci 2018; 63:1908-1910. [DOI: 10.1111/1556-4029.13764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Lauren E. Davis
- Department of Psychiatry; University of Arkansas for Medical Sciences; 4301 W. Markham Street, #554 Little Rock AR 72205 USA
| | - Samidha Tripathi
- Department of Psychiatry; University of Arkansas for Medical Sciences; 4301 W. Markham Street, #554 Little Rock AR 72205 USA
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Mzimbiri JM, Li J, Xia Y, Yuan J, Liu J, Liu Q. Surviving Penetrating Brainstem Injury by Bamboo Sticks: Rare Case Reports and a Brief Review of Literature. Neurosurgery 2016; 78:E753-60. [PMID: 26813854 DOI: 10.1227/neu.0000000000001198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Chopsticks are common utensils used in many Asian cultures. However, they sometimes can be used as weapons or can cause accidents, particularly in children. Penetrating transorbital/transpharyngeal intracranial injuries with bamboo sticks are peculiar accidents and are relatively rare. Because of their rarity, the management of such injuries is often complex. We discuss 3 cases of penetration of the brainstem by bamboo sticks, 1 case through the foramen magnum, which, to the best of our knowledge, is the first reported case of such an injury. CLINICAL PRESENTATION The case of a 50-year-old man who was stabbed with a pair of chopsticks in his left eye is presented. The chopsticks passed through the cavernous sinus, and the patient sustained superior orbital fissure syndrome. The other 2 cases were those of a 4-year-old girl having a similar pattern but different mechanism of injury and a 2-year-old boy who sustained transpharyngeal intracranial injury via the foramen magnum. Computed tomography, magnetic resonance imaging, and computed tomographic angiography (CTA) are the key imaging modalities frequently used to determine the course and extent of brain injury. CONCLUSION Early surgical exploration by a multidisciplinary team approach is essential for attaining a favorable outcome. All cases demonstrated good postoperative recovery and were successfully managed by removing the foreign body through its trajectory. We discuss and briefly review the literature on patterns, complications, and management issues of these less common injuries.
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Affiliation(s)
- Juma M Mzimbiri
- ‡Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China;§Department of Neurosurgery, Muhimbili Orthopedic and Neurosurgical Institute, Dar es Salaam, Tanzania
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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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Mahalangikar R, Kumar A, Sharma BS. Transorbital Penetrating Intracranial Injury with an Umbrella Wire Causing Cavernous Internal Carotid Artery Injury and Thrombosis. World Neurosurg 2015; 86:513.e15-8. [PMID: 26407931 DOI: 10.1016/j.wneu.2015.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transorbital penetrating intracranial injuries, though rare, can have serious consequences. Intracranial penetration can be present even if orbital trauma is trivial. CASE DESCRIPTION We report an unusual case of transorbital penetrating intracranial injury with umbrella wire, sustained while opening an umbrella, leading to internal carotid artery injury and thrombosis. The patient sustained only ipsilateral third nerve palsy that completely recovered during followup. CONCLUSION Trivial orbital injuries can be associated with significant intracranial injury in a neurologically intact patient. This case emphasizes the potentially injury-prone opening mechanism of conventional umbrellas. A high index of suspicion is important while evaluating such patients.
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Affiliation(s)
- Raman Mahalangikar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Bhawani S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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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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Ahmad SS, Ghani SA, Peng KS, Sellamuthu P. 5-year-old girl with left upper eyelid swelling. Digit J Ophthalmol 2012; 18:15-7. [PMID: 23847451 DOI: 10.5693/djo.03.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Syed Shoeb Ahmad
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
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Shin TH, Kim JH, Kwak KW, Kim SH. Transorbital penetrating intracranial injury by a chopstick. J Korean Neurosurg Soc 2012; 52:414-6. [PMID: 23133735 PMCID: PMC3488655 DOI: 10.3340/jkns.2012.52.4.414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/28/2012] [Accepted: 10/04/2012] [Indexed: 12/14/2022] Open
Abstract
A 38-year-old man fell from a chair with a chopstick in his hand. The chopstick penetrated his left eye. He noticed pain, swelling, and numbness around his left eye. On physical examination, a linear wound was noted at the medial aspect of the left eyelid. Noncontrast computed tomography (CT) study showed a linear hypodense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body. This foreign body was hyperdense relative to normal parenchyma. From a CT scan with 3-dimensional reconstruction, the foreign body was found to be passing through the optic canal into the cranium. The clear plastic chopstick was withdrawn without difficulty. The patient was discharged home 3 weeks after his surgery. A treatment plan for a transorbital penetrating injury should be determined by a multidisciplinary team, with input from neurosurgeons and ophthalmologists.
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Affiliation(s)
- Tae-Hee Shin
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
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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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Teymoorian S, San Filippo A, Wallace B. Nonblinding, Penetrating Orbital Injury with Pontine and Cerebellar Involvement Secondary to Antenna Trauma. J Neuroimaging 2011; 22:201-3. [PMID: 21281381 DOI: 10.1111/j.1552-6569.2010.00519.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Savak Teymoorian
- University of Missouri, Department of Ophthalmology, Kansas City, Missouri, MO, USA.
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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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Young AS, Shiels WE, Murakami JW, Coley BD, Hogan MJ. Self-embedding behavior: radiologic management of self-inserted soft-tissue foreign bodies. Radiology 2010; 257:233-9. [PMID: 20823372 DOI: 10.1148/radiol.10091566] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To report on a series of self-embedding behavior (SEB), demonstrate the effectiveness and clinical effect of image-guided foreign body removal (IGFBR) in the treatment of embedded soft-tissue foreign bodies (STFBs), and evaluate the role of the radiologist in the clinical management of SEB. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. From a database of 600 patients treated with IGFBR with ultrasonographic (US) and/or fluoroscopic guidance, self-injury was identified in 11 (1.8%) mainly adolescent patients with a mean age of 16 years (age range, 14-18 years). Evaluated data included number of foreign bodies; number of repeat episodes of foreign body insertion; location, type, and size of foreign body; incision size; imaging modality; and success or failure of foreign body removal. RESULTS Seventy-six foreign bodies were inserted into the arm (n = 69), neck (n = 4), ankle (n = 1), foot (n = 1), or hand (n = 1) in the 11 patients. The number of STFBs per case ranged from one to 15. Foreign body types included metal (n = 40), plastic (n = 15), graphite (n = 12), glass (n = 4), wood (n = 3), crayon (n = 1), and stone (n = 1). STFB dimensions were 2.5-160.0 mm in length by 0.25-3.0 mm in thickness. Sixty-eight of the 76 STFBs were removed in the interventional radiology section. Incision lengths ranged from 4 to 8 mm (mean, 6 mm). The STFBs were removed with US guidance (n = 43), fluoroscopic guidance (n = 15), or a combination of the two modalities (n = 10). IGFBR was successful in all 68 cases, without complications. CONCLUSION Greater awareness of SEB may result in radiologists being the first physicians to identify SEB and rapidly mobilize an interdisciplinary team for early and effective intervention and treatment. Percutaneous radiologic treatment of self-imbedded STFBs is safe, precise, and effective for radiopaque and nonradiopaque foreign bodies.
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Affiliation(s)
- Adam S Young
- Department of Radiology and Children's Radiological Institute, Nationwide Children's Hospital, Columbus, OH 43201, USA
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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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Calvo-Rubal A, Martínez F, Tarigo A. Lesión intracraneal transorbitaria por florete. Caso clínico. Neurocirugia (Astur) 2006. [DOI: 10.1016/s1130-1473(06)70321-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE To review the pathogenesis, clinical characteristics, and management of self-inflicted eye injuries. METHODS Review of the medical literature. RESULTS Psychiatric theories of pathogenesis for self-inflicted behaviour include religious and sexual ideation, symbolism, guilt, and displacement. Biological theories include disorders of serotonergic, dopaminergic, and opiate neurotransmitters. Clinical characteristics of self-mutilators include acute or chronic psychoses, drug-induced psychoses, other psychiatric conditions, and certain organic states. The majority are young-to-early middle-aged male subjects, though it can also rarely occur in children. Management of self-inflicted eye injury requires close cooperation between ophthalmologists and psychiatrists as well as other medical specialists, to ensure quick resuscitation of the patient, prompt diagnosis and treatment of any injuries, and treatment of the underlying behaviour that led to the injuries. CONCLUSIONS Self-inflicted eye injuries are a rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the often severely disturbed patient.
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Affiliation(s)
- N Patton
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, UK.
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Andrade GCD, Silveira RL, Arantes AA, Fonseca Filho GA, Pinheiro N. [Penetrating brain injury due to a large asbestos fragment treated by decompressive craniectomy: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1104-7. [PMID: 15608979 DOI: 10.1590/s0004-282x2004000600033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.
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