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Siddiqui AR, Kariem K, Fayaz M, Scalia G, Chaurasia B. Transorbital penetrating intracranial injury involving bilateral frontal lobes with evisceration of right eye: A case report. Clin Case Rep 2024; 12:e9018. [PMID: 38827937 PMCID: PMC11142902 DOI: 10.1002/ccr3.9018] [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] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
Key Clinical Message Timely diagnosis, multidisciplinary surgical intervention, and appropriate imaging are crucial in managing transorbital-penetrating intracranial injuries (TOPIs), minimizing morbidity, and optimizing patient outcomes. Abstract Transorbital-penetrating intracranial injuries (TOPIs) are rare occurrences with potential for severe neurological complications and high mortality rates. Prompt diagnosis and management are essential to mitigate adverse outcomes. Understanding injury patterns and employing appropriate imaging modalities are crucial for effective surgical planning and patient care. We present a case of a 22-year-old male mechanic who sustained a TOPI involving bilateral frontal lobes with evisceration of the right eye following a workplace accident with a metal cutter. Upon arrival at the emergency department, the patient exhibited vision loss in the right eye, proptosis, and a dilated pupil. Imaging studies revealed the trajectory of a metal arrow through the right orbital roof, necessitating surgical intervention. A multidisciplinary team performed bifrontal craniectomy with duroplasty to remove the foreign body and address associated injuries. Postoperatively, the patient received broad-spectrum antibiotics and anticonvulsants, leading to full recovery and discharge on postoperative day 10. TOPIs present unique challenges due to their rarity and potential for devastating consequences. Our case highlights the importance of timely diagnosis, meticulous surgical planning, and multidisciplinary collaboration in achieving favorable outcomes. Radiological imaging plays a crucial role in guiding treatment decisions and optimizing patient care. This report underscores the significance of early surgical intervention, antimicrobial therapy, and prophylactic measures in reducing morbidity and mortality associated with TOPIs.
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Affiliation(s)
- Abdul Rehman Siddiqui
- Department of NeurosurgerySuper Specialty Hospital GMC, Shireen Bagh SrinagarSrinagarIndia
| | - Kaiser Kariem
- Department of NeurosurgerySuper Specialty Hospital GMC, Shireen Bagh SrinagarSrinagarIndia
| | - Mohsin Fayaz
- Department of NeurosurgerySher‐i‐Kashmir Institute of Medical SciencesSrinagarIndia
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryGaribaldi HospitalCataniaItaly
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2
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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Innocenti M, Pelotti S, Fais P. Bicycle injuries: A systematic review for forensic evaluation. Forensic Sci Int 2024; 359:112027. [PMID: 38677158 DOI: 10.1016/j.forsciint.2024.112027] [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: 11/01/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite not achieving high speeds, bicyclists remain vulnerable to severe and even fatal injuries when they are involved in traffic accidents. Although the rising awareness of ecological issues and traffic law enforcement mean that cyclists are increasingly susceptible to road traffic crashes and injuries. Injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence. The aim of this study is to provide a systematic review of the literature on injuries sustained in cyclists involved in road accidents describing and analysing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus, and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving bicycles. A total of 128 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the bicycle accident was examined and discussed. This review highlights that injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence and the energy levels involved in the crash. The assessment of injuries offers valuable insights that integrated with circumstantial and engineering data perform the reconstruction of accident dynamics.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Maria Paola Bonasoni
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy.
| | - Mattia Innocenti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna,, Via Irnerio 49, Bologna 40126, Italy
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Kim SJ, Jung IH, Chung J. Fencing Knife-Induced Transorbital Penetrating Brain Injury: A Case Report. Korean J Neurotrauma 2023; 19:363-369. [PMID: 37840610 PMCID: PMC10567522 DOI: 10.13004/kjnt.2023.19.e48] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Penetrating brain injury (PBI) is a rare type of traumatic brain injury, which accounts for 0.4% of all head trauma cases. In this study, we describe a 14-year-old male adolescent who sustained a transorbital penetrating injury caused by a fencing knife. Although the patient visited the hospital after the foreign body had been removed, we diagnosed a PBI based on identification of a linear injury trajectory extending from an orbital roof fracture to the contralateral parietal lobe, using three-dimensional reconstruction of the hemorrhage. The patient fully recovered after conservative treatment. We hope that sharing our experience will serve as a guideline for the clinical management of PBI.
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Affiliation(s)
- Sung Jin Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - In-Ho Jung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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Trakulpanitkit A, Sungkaro K. Transorbital Intracranial Penetrating Injury from a Homemade Gun: A Case Report. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1748759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractA transorbital intracranial penetrating injury (TOPI) is an unusual traumatic brain injury that requires multidisciplinary management. TOPI may cause traumatic cerebrovascular injury (TCVI) and fatal brain damage with a high mortality rate. Herein, the authors described an 8-year-old male patient who was injured from a handmade gun; a projectile (marble) had penetrated the left frontal base via the left orbit. TOPI caused left anterior cerebral artery compression. A transorbital approach with an intraoperative transcranial approach on standby was performed to remove the foreign body. Postoperative intensive broad-spectrum antibiotics were administrated, and the patient made an uneventful recovery. In summary, TOPI is an uncommon TBI that risks TCVI. Intracranial vascular investigation should be performed before surgical management, and postoperative complications, such as meningitis, brain abscess, and delayed pseudoaneurysm, should be monitored.
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Affiliation(s)
- Avika Trakulpanitkit
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanisorn Sungkaro
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Sheikh NA, Ateriya N, Khan G, Singh A, Raj K. Fatal transorbital-intracranial penetrating injury- A case report. J Forensic Leg Med 2021; 85:102288. [PMID: 34823205 DOI: 10.1016/j.jflm.2021.102288] [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: 09/04/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Transorbital injuries are rare and may lead to fatal craniocerebral damage. Ocular penetrating injuries account for 24% of all penetrating head injuries in adults, while this percentage goes up to 45% in children. Any penetrating injury through the eyes may enter the intracranial cavity and might prove fatal to the victim owing to cerebral tissue damage and complex management. The dead bodies of three victims were found by the side of the river with multiple injuries to their eyes. Further examination revealed that they had sustained multiple transorbital-intracranial injuries. In such cases, identifying injury patterns is vital so that cause and manner of death can be determined precisely. A thorough postmortem examination can help identify the alleged weapon involved in the act and may clear the doubts concerned with the manner of death.
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Affiliation(s)
- Nishat Ahmed Sheikh
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences Gorakhpur, Uttar Pradesh, 273008, India
| | - Navneet Ateriya
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences Gorakhpur, Uttar Pradesh, 273008, India.
| | - Ghyasuddin Khan
- State Medicolegal Expert, State Medicolegal Cell, Lucknow, Uttar Pradesh, 226004, India
| | - Anurima Singh
- Department of Forensic Medicine & Toxicology, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, 225003, India
| | - Kumar Raj
- TBI Hospital, Mirzapur, Uttar Pradesh, 231001, India
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Agrawal A, Kumar VAK, Kiran NAS, Penchalaiah B, Vinay H. Double Beveling on Imaging: A Characteristic Feature of Entry and Exit Penetrating Injury Wound. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractBeveling of the calvarial bone is reported in firearm exit wounds and stabbing injuries in forensic literature. Beveling in entry wounds is rare. We report a case of a 27-year-old man who sustained a nonfatal penetrating craniofacial injury due to motorbike brake handle, and completely recovered after conservative management. We describe the characteristic inward as well outward beveling on imaging due the penetrating trajectory of the motorbike break handle.
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Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - VA Kiran Kumar
- Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - NA Sai Kiran
- Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Bathalapalli Penchalaiah
- Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Harsha Vinay
- Department of Oral and Maxillofacial Surgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
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Transorbital-penetrating intracranial injury due to a homemade metal arrow: A case report. Ann Med Surg (Lond) 2020; 57:183-189. [PMID: 32774851 PMCID: PMC7398978 DOI: 10.1016/j.amsu.2020.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 11/21/2022] Open
Abstract
A transorbital-penetrating intracranial injury (TOPI) is an unusual traumatic brain injury. This rare injury has the potential to result in serious and fatal brain damage with a high mortality rate and requires prompt multidisciplinary surgical intervention. Here, we describe an interesting case in which a patient who presented with accidental penetrating injuries of the brain was found to have a transorbital-penetrating intracranial injury (TOPI). We chose an anterior approach to the foreign body above the entrance wound for removal in a retrograde manner with fluoroscopic guidance. The patient remained well with no complications and was discharged on postoperative day 10. Reasonable diagnostic imaging, surgical planning, and careful post-surgery management can increase patients successful outcomes. A transorbital-penetrating intracranial injury (TOPI) is an uncommon traumatic brain injury. TOPIs have the potential to result in serious brain damage with a high mortality rate. An interesting case of accidental TOPI that was treated successfully with fluoroscopic guidance is presented.
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Mohapatra SD, Das J, Bhattacharjee H. An unusual case of orbitocranial wooden foreign body with amazing outcome: A case report. Indian J Ophthalmol 2020; 68:219-221. [PMID: 31856530 PMCID: PMC6951121 DOI: 10.4103/ijo.ijo_569_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Penetrating orbitocranial injuries can present with foreign body/bodies (FBs) lodged in eye, orbit, and/or brain. But limited literatures are available about FBs lodged partly in orbit and partly intracranially. Here, we present a rare case of orbitocranial wooden FB impacted in right palpebral aperture extending intracranially following accidental fall from height. Unexpectedly, the patient himself removed the FB in fully conscious and oriented state while waiting for neurosurgical intervention, later completely recovered under observation and antibiotic prophylaxis. Therefore, it is important to have high suspicion of intracranial extension in impacted orbital FBs and a team approach for managing such cases.
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Management of Penetrating Skull Base Injury: A Single Institutional Experience and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2838167. [PMID: 28828384 PMCID: PMC5554568 DOI: 10.1155/2017/2838167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/18/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Penetrating skull base injury (PSBI) is uncommon among head injuries, presenting unique diagnostic and therapeutic challenges. Although many cases of PSBIs have been reported, comprehensive understanding of its initial diagnosis, management, and outcome is still unavailable. MATERIALS AND METHODS A retrospective review was performed for patients treated in neurosurgical department of Changzheng Hospital for PSBIs. Presurgical three-dimensional (3D) Slicer-assisted reconstructions were conducted for each patient. Then we reviewed previous literature about all the published cases of PSBIs worldwide and discussed their common features. RESULTS A total of 5 patients suffering PSBIs were identified. Penetrating points as well as the surrounding neurovascular structures were clearly visualized, assisting in the presurgical planning of optimal surgical approach and avoiding unexpected vascular injury. Four patients underwent craniotomy with foreign bodies removed successfully and 1 patient received conservative treatment. All of them presented good outcomes after proper management. CONCLUSION Careful physical examination and radiological evaluation are essential before operation, and angiography is recommended for those with suspected vascular injuries. 3D modeling with 3D Slicer is practicable and reliable, facilitating the diagnosis and presurgical planning. Treatment decision should be made upon the comprehensive evaluation of patient's clinicoradiological features and characteristics of foreign bodies.
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Riley JP, Boucher AB, Kim DS, Barrow DL, Reynolds MR. The Role of Intraoperative Cerebral Angiography in Transorbital Intracranial Penetrating Trauma: A Case Report and Literature Review. World Neurosurg 2017; 97:761.e5-761.e10. [DOI: 10.1016/j.wneu.2016.09.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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11
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Nonmissile Penetrating Injury to the Head: Experience with 17 Cases. World Neurosurg 2016; 94:529-543. [PMID: 27350299 DOI: 10.1016/j.wneu.2016.06.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Penetrating nonmissile injuries to the head are far less common than missile penetrating injuries. Here we describe our experience in managing 17 cases of nonmissile injury to the head, likely the largest such series reported to date. We also highlight the surgical steps and techniques used to remove in situ objects (including weapons) in the penetrating wounds that have not been described previously. METHODS We conducted a retrospective study of cases of nonmissile, low-velocity penetrating injuries of the head managed in our department. The recorded data of patients with penetrating head injuries were studied for the cause of the injury, type of object, type and extent of penetration, Glasgow Coma Scale score on admission, other clinical issues, evaluation and assessment, interval from penetration to operation, surgical steps and notes, difficulty during the operation, major and minor complications, follow-up, and ultimate outcome. RESULTS Our 17 cases included 6 cases of accidental penetration and 11 cases of penetration as the result of violence. Weapons and other foreign objects causing injury included a teta (a pointed metal weapon with a wooden handle and a barb near the tip, used for hunting and fishing) in 4 cases, a dao (a sharp metal cutting instrument with a wooden handle used for cutting vegetables, fish, meat, bamboo, wood, etc.) in 3 cases, a bamboo stick in 3 cases, a metal rod in 2 cases, a knife in 2 cases, a sharp stone in 1 case, a metal steam chamber cover in 1 case, and a long peg in 1 case. GCS on admission was between 13 and 15 in 15 cases. Only 1 patient exhibited limb weakness. Four patients with an orbitocranial penetrating injury had 1-sided vision loss; 2 of these patients had orbital evisceration, and 1 of these patients died. In 14 patients, the foreign object was in situ at presentation and was removed surgically. Computed tomography scan and plain X-ray of the head were obtained in all patients. Postoperatively, 2 patients (11.7%) needed support in the intensive care unit but died early after surgery. One patient developed late osteomyelitis. The remaining patients were doing well at the most recent follow-up. CONCLUSIONS The presenting picture of nonmissile penetrating injury to head may be daunting, but these cases can be managed with very good results with proper (clinical and radiologic) evaluation and simple neurosurgical techniques.
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Moussa WMM, Abbas M. Management and outcome of low velocity penetrating head injury caused by impacted foreign bodies. Acta Neurochir (Wien) 2016; 158:895-904; discussion 904. [PMID: 26973055 DOI: 10.1007/s00701-016-2764-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/29/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Penetrating head injuries with impacted foreign bodies are rare, associated with a high incidence of morbidity and potentially life-threatening. In this study, we aimed at investigating the outcome of these cases as well as analyzing the factors affecting the prognosis. METHODS A retrospective study in which the records of 16 patients who had penetrating head injuries caused by low-velocity impacted foreign bodies were revised. All patients were males with a mean age of 28.9 years (range, 18 to 50 years). The follow-up period ranged from 4 to 13 months with a mean of 8.1 months. Causes of injury were construction accidents in 6 (37.5 %) patients, assault in 6 (37.5 %) and road traffic accidents in 4 (25 %). The impacted objects included a bar of iron, a piece of wood, a nail, a sickle and a piece of glass. Diagnostic computerized tomography (CT) of the brain was carried out on admission in all patients. Thirteen (81.3 %) patients were submitted to surgery, and all had the appropriate management in the form of antibiotics and dehydrating measures as required. The primary outcome measure was the Glasgow Outcome Scale (GOS) at the end of follow-up. RESULTS At the end of follow-up, ten (62.5 %) patients had a GOS score of 5, two (12.5 %) patients had a score of 4, and four (25 %) patients had a score of 1. CONCLUSIONS Low-velocity penetrating head injuries are most common in young adult males. With the appropriate management, a majority of even the most severe cases can have a favorable outcome.
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Affiliation(s)
- Wael Mohamed Mohamed Moussa
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champollion Street, El Khartoum Square, Azareeta, Alexandria, Egypt.
| | - Mohamed Abbas
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champollion Street, El Khartoum Square, Azareeta, Alexandria, Egypt
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Poroy C, Cibik C, Yazici B. Traumatic Globe Subluxation and Intracranial Injury Caused by Bicycle Brake Handle. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e33405. [PMID: 27800464 PMCID: PMC5078721 DOI: 10.5812/atr.33405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 11/16/2022]
Abstract
Introduction Case Presentation Conclusions
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Affiliation(s)
- Ceren Poroy
- Department of Ophthalmology, Uludag University, Bursa, Turkey
| | - Cansu Cibik
- Department of Ophthalmology, Uludag University, Bursa, Turkey
| | - Bulent Yazici
- Department of Ophthalmology, Uludag University, Bursa, Turkey
- Corresponding author: Bulent Yazici, Department of Ophthalmology, Uludag University, Bursa, Turkey. Tel: +90-2242952415, Fax: +90-2444428070, E-mail:
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14
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Bone beveling caused by blunt trauma: a case report. Int J Legal Med 2015; 130:771-5. [PMID: 26585737 DOI: 10.1007/s00414-015-1293-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
The authors report a fatal case of blunt trauma to the skull caused by a rib of a beach umbrella. The skull displayed a round hole in the right temporal bone with typical internal beveling. Blunt trauma mimicking a gunshot wound (round perforation of the skull with internal beveling) is very rarely reported in the forensic literature.
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Agrawal A, Reddy VU, Kumar SS, Hegde KV, Rao GM. Transorbital Orbitocranial Penetrating Injury with an Iron Rod. Craniomaxillofac Trauma Reconstr 2015; 9:145-8. [PMID: 27162571 DOI: 10.1055/s-0035-1551545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/31/2015] [Indexed: 10/23/2022] Open
Abstract
Transorbital orbitocranial penetrating injuries (TOPIs) are relatively rare, can be caused by high-speed projectile foreign bodies to low-energy trauma (which is rarer), and account for 24% of penetrating head injuries in adults and approximately 45% in children. We report an uncommon nonfatal case of TOPI where a 16-year-old male child sustained injury due to accidental penetration of metal bar into the forehead. A bicoronal flap was raised to remove the metal bar. The patient recovered well, had normal vision, and doing well at follow-up.
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Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - V Umamaheswara Reddy
- Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - S Satish Kumar
- Department of Emergency Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Kishor V Hegde
- Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - G Malleswara Rao
- Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
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Tewari VK, Dubey RS, Dubey GC. Trans-orbital orbitocranial penetrating injury by pointed iron rod. J Neurosci Rural Pract 2015; 6:231-3. [PMID: 25883487 PMCID: PMC4387818 DOI: 10.4103/0976-3147.150282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Trans-orbital orbitocranial penetrating injury (TOPI) by a foreign body is an extremely rare compound head injury having a potential to cause major morbidity and mortality. Preoperative radiological imaging by CT scan is very important for operative guidance, but in remote area where CT scan is not available, the patient is generally referred to tertiary level. Here we present a case which was dealt successfully without CT scan, only on the basis of stable clinical status and X-rays. We present a case of a 35-year-old man who had an accidental injury (fall from height) by rod. Immediate X-ray (anteroposterior and lateral views) revealed that the pointed end of the foreign body (rod) was inside the ipsilateral anterior fossa via basifrontal bone up to frontal vertex, not crossing the midline. CT scan was not available and his vitals with GCS were normal (15/15). He was operated with the help of an ophthalmic surgeon by right frontotemporal craniotomy. The patient was discharged on 10th day without any neurological deficit except restricted right eyeball movement to superolateral and ptosis. The restricted eyeball movements recovered after third month of follow up with remnant ptosis for 2 years. This case highlights an unusual case, direct visualization and repair of brain structures with higher antibiotics can save the life even in remote areas where CT scan is still not available only on the basis of stable GCS and X-rays.
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Affiliation(s)
- Vinod Kumar Tewari
- Department of Neurosurgery, Ram Manohar Lohia Hospital, Lucknow, Uttar Pradesh, India
| | - Ram Shringar Dubey
- Department of Surgery, Ram Manohar Lohia Hospital, Lucknow, Uttar Pradesh, India
| | - Gyan Chand Dubey
- Department of Opthalmology, Ram Manohar Lohia Hospital, Lucknow, Uttar Pradesh, India
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17
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Agrawal A. Trans-orbital penetrating head injury. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Transorbital stab injury with retained knife: a narrow escape. Case Rep Crit Care 2014; 2014:754053. [PMID: 25328717 PMCID: PMC4189941 DOI: 10.1155/2014/754053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
Transorbital penetrating injuries are unusual but may cause severe brain damage if cranium is entered. These kinds of injuries are dangerous as the walls of orbit are very thin, hence easily broken by the otherwise innocent objects. Because of the very critical anatomical area involved, these injuries pose a serious challenge to the physicians who first receive them as well as the treating team. These may present as trivial trauma or may be occult and are often associated with serious complications and delayed sequel. Prompt evaluation by utilizing best diagnostic modality available and timely interference to remove them are the key aspects to avoid damage to vital organs surrounding the injury and to minimize the late complications. We report a case of transorbital assault with a 13 centimeter long knife which got broken from the handle and the blade was retained. The interesting aspect is that there was no neurological deficit on presentation or after removal.
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Gupta O, Roy K, Ghosh S, Tripathy P. An unusual penetrating transorbital craniocerebral injury. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arslan M, Eseoğlu M, Güdü BO, Demir I. Transorbital orbitocranial penetrating injury caused by a metal bar. J Neurosci Rural Pract 2012; 3:178-81. [PMID: 22865972 PMCID: PMC3409991 DOI: 10.4103/0976-3147.98228] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Transorbital intracranial injury is uncommon, representing 0.04% of penetrating head trauma with a high mortality rate. Orbital penetrating injuries may cause severe brain injury if the cranium is entered, typically via the orbital roof, the superior orbital fissure, or the optic canal. A 13-year-old male sustained a severe brain injury due to penetration of the right orbit with an iron bar. The bar entered the inferiomedial aspect of the orbit and emerged from the left occipital bone. Neurological examination revealed deep coma (GCS: E1M2V1) with fixed, dilated, and non-reactive pupils. The bar followed an intracranial trajectory, through the third ventricle and suprasellar cistern. The patient underwent an immediate exploration with removal of the bar. Unfortunately, he died 10 days postoperatively due to severe diencephalic injury with brainstem herniation. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.
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Affiliation(s)
- Mehmet Arslan
- Department of Neurosurgery, Yuzuncu Yıl Univercity, School of Medicine, Van, Turkey
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21
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Huiszoon WB, Noë PN, Manten A. Fatal transorbital penetrating intracranial injury caused by a bicycle hand brake. Int J Emerg Med 2012; 5:34. [PMID: 22989177 PMCID: PMC3517487 DOI: 10.1186/1865-1380-5-34] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/14/2012] [Indexed: 11/10/2022] Open
Abstract
A transorbital penetrating intracranial injury is a rare and severe traumatic brain injury. Patients with this type of injury may present dramatically, but often the injury is subtle and therefore easily overlooked and not recognized in the first place. We present the case of a 45-year-old female admitted to the emergency department after she fell with her bike and the bicycle brake handle penetrated her left eye. A computerized tomography of the cerebrum showed a fracture of the superior orbital roof with multiple bone fragments extending into the brain near the circle of Willis. A pneumocephalus and traumatic frontobasal, intraventricular and subdural hemorrhage was seen. The patient deteriorated suddenly and was transferred to a neurosurgical center where she underwent an emergency craniotomy with evacuation of the intracerebral hematoma and an intraventricular drain was placed. After surgery, the patient's condition deteriorated, and total compression of the brain stem occurred, upon which the patient was declared brain dead. Our case report shows that the Glasgow Coma Scale score at admission is not always a good predictor of the severity of the injury. Even when there is minimal suspicion of a penetrating intracranial injury, a computerized tomography should be performed immediately, independent of the patient's Glasgow Coma Scale score. A direct transfer to a specialized neurosurgical center is recommended because this injury often results in death due to fatal complications such as intracerebral hemorrhage, pneumocephalus and brain stem injury.
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Affiliation(s)
- Willemijn B Huiszoon
- Department of Critical Care, Meander Medical Center, Utrechtseweg 160, Amersfoort, ES 3818, the Netherlands.
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Natrella M, Duc L, Lunardi G, Cristoferi M, Fanelli G, Meloni T. Treatment of a transorbital penetrating injury: a particular endovascular approach. Interv Neuroradiol 2012; 18:191-4. [PMID: 22681735 DOI: 10.1177/159101991201800211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 03/03/2012] [Indexed: 11/17/2022] Open
Abstract
The management of craniocerebral penetrating injury currently represents a challenge for neurosurgeons and neuroradiologists and requires innovative planning. This report describes the case of a worker admitted to hospital with an intracranial piece of concrete-cutting saw stuck through the right eye. At the time of admission the patient was conscious and this fact influenced the choice of a particular approach. This patient escaped without neurological deficit or complications, except for the inevitable removal of an eye.
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Affiliation(s)
- M Natrella
- Department of Imaging and Interventional Radiology, Umberto Parini Regional Hospital, Aosta, Italy.
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Kataria R, Singh D, Chopra S, Sinha VD. Low velocity penetrating head injury with impacted foreign bodies in situ. Asian J Neurosurg 2011; 6:39-44. [PMID: 22059103 PMCID: PMC3205550 DOI: 10.4103/1793-5482.85635] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Penetrating head injury is a potentially life-threatening condition. Penetrating head injuries with impacted object (weapon) are rare. The mechanism of low velocity injury is different from high velocity missile injury. Impacted object (weapon) in situ poses some technical difficulties in the investigation and management of the victims, and if the anticipated problems are not managed properly, they may give rise to serious consequences. The management practice of eight patients with impacted object in situ in context of earlier reported similar cases in literature is presented.
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Affiliation(s)
- Rashim Kataria
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
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Koyanagi M, Sakai N, Adachi H, Ueno Y, Kunieda T, Imamura H, Kikuchi H. Penetrating brain injury caused by retained plastic tip of ballpoint pen. Pediatr Neurosurg 2011; 47:462-3. [PMID: 22777381 DOI: 10.1159/000339210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/26/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Masaomi Koyanagi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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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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Abstract
Penetrating cranionasal injuries are relatively rare, usually occur in young children, and can be caused by a variety of unusual objects. The mortality and disability rates are high without appropriate treatment. We report a penetrating cranionasal injury caused by a bicycle spoke. Some fundamental principles in the diagnosis and treatment of penetration injuries are emphasized from this case and the surrounding literature reviewed.
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Paiva WS, Monaco B, Prudente M, Soares MS, de Amorim RLO, de Andrade AF, Teixeira MJ. Surgical treatment of a transorbital penetrating brain injury. Clin Ophthalmol 2010; 4:1103-5. [PMID: 20957055 PMCID: PMC2952611 DOI: 10.2147/opth.s9638] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Penetrating injury of the skull and brain are relatively uncommon events, representing about 0.4% of all head injuries. Transorbital penetrating brain injury is an unusual occurrence in emergency practice and presents with controversial management. We report the case of a 10-year-old boy who fell forward on a bamboo stick while playing with other children, causing a penetrating transorbital injury, resulting in meningitis. We performed a combined surgical approach with neurosurgeons and ophthalmogic surgeons. Upon discharge, the patient had a Glasgow Coma Scale score of 15, no motor deficit and no visual loss. We discuss the management of this case and review current literature.
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Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bernardo Monaco
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcelo Prudente
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Matheus Schimidt Soares
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Almir Ferreira de Andrade
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
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Noda E, Inoue M, Yoshikawa-Kobayashi I, Nagamoto T. Perforating eyelid injury extending to the brain stem in a 17-year-old woman: a case report. J Med Case Rep 2010; 4:18. [PMID: 20205766 PMCID: PMC2822793 DOI: 10.1186/1752-1947-4-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 01/21/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction This case report describes a patient who had a perforating eyelid injury that extended to the brain stem. Case presentation A 17-year-old Japanese woman complained of decreased vision in her right eye, with severe ocular pain and headaches, after the metal tip of an umbrella struck her upper right eyelid accidentally. Her vision in the right eye decreased to light perception with commotio retinae, intraretinal hemorrhage, and severe lid swelling. Magnetic resonance imaging (MRI) demonstrated edema of the head of the caudate nucleus and putamen, and the edema extended to the hypothalamus. The MRI findings indicated that the umbrella tip had penetrated through the eyelid and the posterior orbital wall. Vision improved to 20/50 in the right eye, with subretinal fibrosis caused by the choroidal rupture. Conclusions We recommend that MRI be performed on the orbit and brain in patients who appear to have symptoms that are inconsistent with the observed injury and when a severe orbitocranial injury is suspected.
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Affiliation(s)
- Eiichiro Noda
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo 181-8611, Japan.
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Unusual penetrating head injury in children: personal experience and review of the literature. Childs Nerv Syst 2009; 25:909-13. [PMID: 19452157 DOI: 10.1007/s00381-009-0901-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 03/30/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A penetrating head injury belongs to the most severe traumatic brain injuries, in which communication can arise between the intracranial cavity and surrounding environment. DISCUSSION The authors present a literature review and typical case reports of a penetrating head injury in children. The list of patients treated at the neurosurgical department in the last 5 years for penetrating TBI is briefly referred. Rapid transfer to the specialized center with subsequent urgent surgical treatment is the important point in the treatment algorithm. It is essential to clean the wound very properly with all the foreign material during the surgery and to close the dura with a water-tight suture. Wide-spectrum antibiotics are of great use. In case of large-extent brain damage, the use of anticonvulsants is recommended. CONCLUSION The prognosis of such severe trauma could be influenced very positively by a good medical care organization; obviously, the extent of brain tissue laceration is the limiting factor.
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Shahpurkar VV, Agrawal A. Fatal orbitocranial injury by fencing and spectacle sidebar. Indian J Ophthalmol 2008; 56:345-6. [PMID: 18580007 PMCID: PMC2636176 DOI: 10.4103/0301-4738.41431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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