Serious penetrating craniocerebral injury caused by a nail gun

Suicide by a construction nail fired from a pistol

Penetrating head injury to accomplish suicide by a non-ammunition-related projectile discharged from a nail-gun is a very rare entity. The authors describe even much rarer, and the first reported case of a suicide penetrating head injury by a construction nail discharged from a blank cartridge of a pistol. The absence of beveling and muzzle impression, the non-ejection of the discharged cartridge, and the exit of just the tip of the nail from the other side of wound were the atypical features in this firearm fatality sustained at a contact-range. The entry wound prototypes like abrasion and grease collar, and blackening were absent. An improvisation to insert a construction nail into the chamber of firearm, for utilization as a projectile was another unique highlight here. The deceased was a construction builder. Being debt-ridden, he probably could not manage to purchase even one live cartridge for his licensee pistol to bring suicidal ideation to culmination.

Penetrating Orbitocranial Injuries in the Republic of Korea

Objective

Penetrating brain injury occurs when an object enters the skull and pierces the brain. These injuries can damage small or large parts of the brain, are life-threatening, and require emergency care. This study is a summary of penetrating head injuries at our hospital and an analysis of their treatments and prognoses.

Methods

Patients with penetrating brain involving the orbit and/or cranial region were recruited among patients with trauma who visited our regional trauma center between 2019 and 2022.

Results

Eight patients with penetrating brain injuries were enrolled. One patient was female; the median age was 53 years (range, 24-72 years). Five patients with Glasgow Coma Scale (GCS) scores of 14 or 15 showed no major vessel injury or midline intracranial involvement on imaging and were discharged safely. The other three patients with suspected major vessel injuries and midline involvement did not survive.

Conclusion

The greatest influences on patient prognosis were the area of damage and level of consciousness, along with the GCS score at the time of the visit. The probability of survival is extremely low if the midline structure is damaged.

Visual Disturbance Caused by a Nail Gun-Induced Penetrating Brain Injury

<p>Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.</p>

Penetrating Injury of Superior Sagittal Sinus

Penetrating injury of superior sagittal sinus (SSS) is very rare yet serious which can lead to morbidity and mortality. Complications such as bleeding, thrombosis, and infection are possible and should be anticipated. We report a case of 3-year-old boy with penetrating injury caused by a nail at the middle third of SSS. The patient underwent the surgery for extraction and sinus repair and antibiotic treatment during the hospital stay. He was neurologically intact and recovered completely. Comprehensive treatment of both surgical and medical management is important in achieving the best possible outcome.

Treatment of a self-inflicted intracranial nail gun injury

A 30-year-old man walked into the emergency department after a suicide attempt by firing a nail from a pneumatic nail gun directed at his left temple. He was haemodynamically stable and neurologically intact, able to recall all events and moving all extremities with a Glascow Coma Scale of 15. CT of the brain showed a 6.3 cm nail in the right frontal region without major intracerebral vessel disruption. He was taken to the operating room for left temporal wound washout, debridement of gross contamination and closure with titanium cranial fixation plate. The foreign body was not accessible on initial surgical intervention and was left in place to define anatomy and plan for subsequent removal. Thin slice CT images were used to create 3D reconstructions to facilitate stereotactic navigation and foreign body removal via right craniotomy the following day. The patient tolerated the procedures well and recovered with full neurological function.

Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review

Orbitocranial penetrating injury (OPI) with multiple vascular invasions is a rare occurrence. To our knowledge, experience with its clinical treatment is rather limited, especially for infants. This case report describes an infant who fell from a 0.5 m high bed and landed on a toy with a keen-edged plastic rod. The fractured end of the rod was noted at the medial aspect of the left eyelid, and she was experiencing impaired consciousness. Computed tomography showed that the foreign body penetrated the cavernous sinus with internal carotid artery involvement, and compressed the transverse sinus through the cerebellum. Emergency surgery was performed with temporal occlusion of the left common carotid artery. The rod was removed from the orbital side, and bleeding from cavernous sinus region was effectively controlled under direct inspection via a sub-temporal approach. The patient was successfully treated and recovered consciousness after 17 days. This is the first report of successful management of OPI combined with multiple vascular injury in an infant. Herein, we highlight the anatomical imaging features of the injuries and also the individualized strategy concerning vascular invasion.

An unusual patterned injury from homicidal craniocerebral impalement with a metal chair leg

A 26-year-old young man died shortly after he had suffered craniocerebral impalement from a metal chair leg during an affray at an airport bar. At autopsy a 25 mm diameter circular wound was present in the left parietal region with protruding brain tissue. Death was due to craniocerebral trauma from a penetrating injury to the head. Examination of the chair used in the assault showed a metal chair with smeared blood on the front right leg that matched the blood group of the decedent. The fatal wound had been inflicted by the assailant with the victim leaning forward while kneeling on the floor. The assault had produced an unusual circular patterned defect in the left parietal bone with dimensions corresponding to the chair leg. The location of the defect and the use of a chair leg were two very unusual features in this homicide.

Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report

•

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.

Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note

We report a 45-year-old man who suffered a penetrating nail gun injury resulting in damage to the lateral edge of the superior sagittal sinus. The injury was successfully treated via a parasagittal craniotomy that enabled removal of the nail under direct vision, allowing for rapid suturing of the sagittal sinus. Two neurosurgeons worked together; one carefully withdrew the tip of the nail back into the sinus itself while the second rapidly sutured the hole in the inner superior sagittal sinus leaflet. Postoperatively, the patient made a rapid recovery without neurological deficit.

Management of Penetrating Brain Injury Caused by a Nail Gun: Three Case Reports and Literature Review

BACKGROUND

Penetrating brain injury (PBI) caused by a nail gun is an extremely rare neurosurgical emergency that poses a challenge for neurosurgeons because of its rarity and complexity.

CASE DESCRIPTION

Here we present 3 cases of PBI caused by a nail gun. In the first case, the nail entered through the right parietal bone and lodged in the right parietal lobe and basal ganglia. In the second case, the nail entered through the right occipital bone and lodged in the right occipital lobe. In the third case, the nail entered through the right parietal bone and lodged in the right frontal and parietal lobes. All patients underwent surgical removal of the nail. The first patient presented with reduced left-side strength, whereas the second and third patients were neurologically intact on presentation.

CONCLUSIONS

PBI caused by a nail gun can present with differing clinical manifestations, and most cases require immediate surgery. A rational management strategy should provide a good postoperative prognosis with minimal neurologic deficits in these patients.

Nonmissile Penetrating Head Injuries: Surgical Management and Review of the Literature

BACKGROUND

Nonmissile penetrating head injuries (NPHIs) in the civilian population are rare but potentially fatal. Although numerous cases have been reported in the literature, the surgical management of such injuries is still ambiguous, especially with development of surgical techniques. Here, we report 5 cases of NPHIs managed with different surgical techniques and review the literature on surgical treatment of these injuries to outline the appropriate management for these patients from a neurosurgical perspective.

METHODS

We retrospectively reviewed 5 cases of NPHIs managed surgically in our department. The clinical data were collected, including cause, type of objects, way of penetration, initial clinical evaluation, imaging, surgical intervention, postoperative care, complication, follow-up, and outcome. In addition, a systematic review of the literature was performed in the PubMed database to search for articles on surgical treatment of these injuries.

RESULTS

These 5 cases were caused by twisted steel bar, electric welding rod, and sewing needle, respectively. Preoperative imaging, including computed tomography, magnetic resonance imaging, and digital subtraction angiography, was selectively performed to assist the operative plan. Foreign objects were removed surgically in all cases. Postoperative prophylactic administration of antibiotics and anticonvulsants was used to prevent infectious and epileptic complications. Most of the patients achieved a better outcome except for one.

CONCLUSIONS

NPHIs can be fatal but they can be managed with satisfactory results by proper preoperative imaging evaluation, rapid appropriate surgical management, and accurate postoperative care. Personalized surgical intervention should be undertaken depending on the mechanism and extent of the NPHI.