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Wang H, Chen H, Liu C, Yuan L, Bao Y, Zhao G, Wang D, Song G. Successful resuscitation and multidisciplinary management of penetrating brain injury caused by tire explosion: A case report. Medicine (Baltimore) 2022; 101:e32048. [PMID: 36451440 PMCID: PMC9704937 DOI: 10.1097/md.0000000000032048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Penetrating brain injury (PBI) is a rare trauma that presents as a difficult and serious surgical emergency for neurosurgeons in clinical practice. Our patient was admitted with a PBI caused by a tire explosion, which is an extremely rare cause of injury. PATIENT CONCERNS We report a case of a 28-year-old male patient who suffered a PBI when a tire exploded while it was being inflated with a high-pressure air pump. DIAGNOSES The patient was diagnosed with PBI presenting with multiple comminuted skull fractures, massive bone fragments with foreign bodies penetrating the underlying brain tissue of the top right frontal bone, multiple cerebral contusions, and intracranial hematoma. INTERVENTIONS Emergency combined multidisciplinary surgery was performed for the removal of the fragmented bone pieces, hematoma, and foreign bodies; decompression of the debridement flap; reconstruction of the anterior skull base; and repair of the dura mater. OUTCOMES The patient was successfully resuscitated and discharged 1 month later and is now recovering well. LESSONS Patients with PBI are critically ill. Therefore, timely, targeted examinations and appropriate multidisciplinary interventions through a green channel play a key role in assessing the condition, developing protocols, and preventing complications.
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Affiliation(s)
- Haozhan Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Hao Chen
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Changtong Liu
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Long Yuan
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Yonggang Bao
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guodong Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dengqin Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guohong Song
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- * Correspondence: Guohong Song, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Street, Jining 272000, Shandong Province, China (e-mail: )
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Barranco R, Caputo F, Pinto SL, Drommi M, Ventura F. Unusual suicide by a speargun shot: Case report. Medicine (Baltimore) 2020; 99:e22308. [PMID: 33285667 PMCID: PMC7717817 DOI: 10.1097/md.0000000000022308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/25/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Only a few cases of accidental deaths due to speargun injuries are reported in the literature. Murder or suicide cases are even rarer. PATIENT CONCERNS A 59-year-old male with a history of major depression and previous suicide attempts, was found, still alive and conscious, with a spear in his mouth and a fishing speargun a few meters away. The spear then penetrated the cranium and crossed the entire left cerebral hemisphere. DIAGNOSES The patient underwent a retrograde removal of the spear. During the surgery, there was a massive encephalic bleeding. After about 2 days of coma, brain death was confirmed. An autopsy was performed to determine the cause of death. INTERVENTIONS The scalp presented hemorrhagic infiltrates in the left parieto-temporal region. There were an acute subdural hematoma and subarachnoid hemorrhage. At the opening of the lateral ventricles a massive fronto-parieto-temporal hematoma was evident. The skull base had a massive hemorrhagic infiltration and a circular fracture of about 0.5 cm in diameter, due to the penetration of the spear. The hard palate showed a circular solution of continuity with net margins whose diameter was consistent with the size of the spear. OUTCOMES The cause of death was attributed to the traumatic cranial-encephalic lesions due to the speargun shot in the mouth. LESSONS The investigation into unusual cases of death constitutes a complex matter and requires a careful evaluation on the part of the forensic pathologist. A differential diagnosis may be necessary in order to rule out simulated suicide/homicide. In this particular case, the analysis of the scene of the self-suppression event and available circumstantial information, the evaluation of clinical data, the complete autopsy and the comparison between the injuries of the victim and the characteristics of the weapon used led to the confirmation of the suicidal nature of the death.
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Hoz SS, Aljuboori ZS, Dolachee AA, Al-Sharshahi ZF, Alrawi MA, Al-Smaysim AM. Fatal Penetrating Head Injuries Caused by Projectile Tear Gas Canisters. World Neurosurg 2020; 138:e119-e123. [PMID: 32081822 DOI: 10.1016/j.wneu.2020.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since their advent in the 1920s, tear gas canisters (TGCs) have been frequently used in crowd control. Few reports have documented nonpenetrating injuries attributed directly to TGCs. In this study, we report a case series of fatal penetrating head injuries caused by TGCs. METHODS We conducted a retrospective chart review of all the patients who were admitted to the Neurosurgery Teaching Hospital in Baghdad, Iraq, since the start of the antigovernment protests (October 2019). All patients who suffered penetrating head trauma caused by TGCs were included in our study. We collected patient demographics, wound location, neurologic examination, computed tomography (CT) scan findings, surgical management, and clinical outcomes. RESULTS We found 10 cases of penetrating head trauma caused by TGCs. All victims were men, with a mean age of 16 years (range, 14-19 years). The mean Glasgow Coma Scale score was 7 (range, 3-10). The neurologic examination revealed unilateral hemiplegia/hemiparesis and pupillary abnormality in 40% (n = 4) and 50% (n = 5) of the patients, respectively. CT scans revealed an extensive pattern of brain damage. Surgical intervention was done in 80% of cases (n = 8), which included removal of the TGC, wound debridement, and hemostasis. The in-hospital mortality rate was 100% (N = 10), with all fatalities occurring within 1-3 days of admission. CONCLUSIONS TGCs have the potential to cause lethal penetrating head injuries, calling for a reevaluation of their safety and methods of use in terms of human health.
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Affiliation(s)
- Samer S Hoz
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Zaid S Aljuboori
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
| | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | | | - Mohammed A Alrawi
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Ammar M Al-Smaysim
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Abstract
RATIONALE Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage. PATIENT CONCERNS A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region. DIAGNOSIS According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture. INTERVENTION After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed. OUTCOMES After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months. LESSONS In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.
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Affiliation(s)
- Lin Shi
- Department of Neurotraumatology
| | - Yue Sun
- Department of Neurotraumatology
| | - Limin Chen
- Department of Neurology, The First Hospital of Jilin University, Jilin, China
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Solumsmoen S, Lilja-Cyron A, Buch KF, Kelsen J. [Traumatic penetrating brain injury]. Ugeskr Laeger 2018; 180:V03180201. [PMID: 30618364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Penetrating brain injury is a severe form of traumatic brain injury. It is significantly less prevalent than closed head injury but carries a much worse prognosis. The experience with traumatic penetrating brain injury in Denmark is limited. The most common causes in penetrating brain injury in Denmark are: violence, accidents and suicidal behaviour. The aim of this review is to give a brief update on historical background, mechanisms of disease, recommended medical and surgical treatment, and complications. Clinical examples and a treatment algorithm are discussed.
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Zyskowski M, Biberthaler P, Kanz KG. [Penetrating head injurys]. MMW Fortschr Med 2017; 159:39-41. [PMID: 28656411 DOI: 10.1007/s15006-017-9844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Zyskowski
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, Ismaninger Straße 22, D-81675, München, Deutschland.
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität (TU) München, München, Deutschland
| | - Karl-Georg Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität (TU) München, München, Deutschland
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Abstract
Assorted projectiles including shrapnel, sling shots, stones, metal and rock fragments and other missiles cause fatal penetrating skull injuries. In this case, a 34-year-old foreman suffered a fatal penetrating orbito-cerebral injury while lubricating a hydraulic rock-splitting machine with industrial grease viscous.
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Affiliation(s)
- Mohit Chauhan
- Department of Forensic Medicine, MAMC & Associated Hospitals, New Delhi 110002, India
| | - Chittaranjan Behera
- Department of Forensic Medicine, MAMC & Associated Hospitals, New Delhi 110002, India
| | - P C Dikshit
- Department of Forensic Medicine, MAMC & Associated Hospitals, New Delhi 110002, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Füessl HS. [Nail in the head-so what?]. MMW Fortschr Med 2014; 156:33. [PMID: 24908769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
- Lovely Chhabra
- Department of Internal Medicine, Saint Vincent Hospital and University of Massachusetts Medical School, Worcester, MA, USA.
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital and University of Massachusetts Medical School, Worcester, MA, USA
| | - Gerald T McGillicuddy
- Department of Neurosurgery, Saint Vincent Hospital and University of Massachusetts Medical School, Worcester, MA, USA
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11
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Karavaev VM. [A case of suicide committed with a crossbow]. Sud Med Ekspert 2014; 57:45-46. [PMID: 25275186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The paper reports the results of forensic medical expertise of the corpse of a young man who committed suicide by two arrow shots to the head with a MK-80-A4AL crossbow. Both wounds are penetrating brain injuries.
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Abstract
We report the case of successful management of a transcranial penetrating high-energy transfer injury in a 20-year-old soldier. The bullet traversed both cerebral hemispheres and lacerated the superior sagittal sinus rendering him unconscious. We detail the care received at all stages following injury from 'Buddy Aid' on the battlefield, resuscitation by a forward medical team through to prompt neurosurgery within 2 h of injury. Subsequent aeromedical evacuation and continuing aggressive critical care has allowed the patient to survive with acceptable neurological impairment after what is generally considered an unsurvivable injury.
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Affiliation(s)
- Clément Hoffmann
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - E Falzone
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
| | - A Dagain
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - A Cirodde
- Burns Treatment Center, Percy Military Teaching Hospital, Clamart, France
| | - T Leclerc
- Burns Treatment Center, Percy Military Teaching Hospital, Clamart, France
| | - B Lenoir
- Department of Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
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13
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Eren B, Cetin S, Türkmen N, Akan O, Gürses MS, Gündoğmuş UN. An unusual case of penetrating intracranial injury due to scissors. Soud Lek 2013; 58:29-30. [PMID: 23641725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Craniocerebral penetrating non-missile injuries caused by metallic foreign bodies are uncommon events. Healthy 10 year-old boy applied to the hospital emergency service with his parents. Family members stated that the scissors have been stalled his head accidentally by his sister when they had played together. During physical examination the scissors located on left parietal region of the head was examined. There was no loss of consciousness and oriented with normal vital signs. Radiological investigation demonstrated a hyper dense foreign body (scissors) penetrating cranial cavity and ended before reaching posterior region of the left parietal lobe. To our knowledge, the presented was rare case of intracranial penetrating scissor, which was not removed until, injured, reached the hospital. Our goal was to discuss the rare case of penetrating non-missile foreign body cranial injury from medico legal aspect.
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Affiliation(s)
- Bülent Eren
- Bursa Morgue Department, Council of Forensic Medicine of Turkey, Bursa, Turkey.
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14
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Peñafiel Rebutti A, Marco Mouriño A, Cardona Cabezón FJ, Osanz Juan F, Arrtigot Cánovas MR, Tarrés Madero Y. [Cranial nailing, an unusual type of self harm]. Rev Esp Sanid Penit 2011; 13:30-32. [PMID: 21484076 DOI: 10.4321/s1575-06202011000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2001] [Accepted: 02/05/2001] [Indexed: 05/30/2023]
Affiliation(s)
- A Peñafiel Rebutti
- Servicios Sanitarios, Centro Penitenciario de Hombres de Barcelona, Barcelona, España.
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15
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Santín-Amo JM, Castro-Bouzas D, Arcos-Algaba A, Díaz-Cabanas L, Serramito-García R, Bandín-Diéguez FJ, Villa-Fernández JM, Gelabert-González YM. [Intracranial injury caused by captive bolt gun]. Neurocirugia (Astur) 2010; 21:491-495. [PMID: 21165547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Guns bullet or captive bolt is used as a weapon for stunning animals as a prelude to sacrifice. Placed in front of it induce an immediate loss of consciousness, thus achieving a "humanization" of process. It's use for suicide is rare, almost exclusively of people who have access to them because of their occupation, causing severe injuries to the brain. We analyse three cases presented in our service. One of them dies as a result of injuries.
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Affiliation(s)
- J M Santín-Amo
- Servicio de Neurocirugía, Hospital Clínico Universitario de Santiago, Departamento de Cirugía, Universidad de Santiago de Compostela
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16
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Serramito-García R, Arcos-Algaba A, Santín-Amo JM, García-Allut A, Bandín-Diéguez FJ, Gelabert-González M. [Epidural haematoma due to an headrest in an adult]. Neurocirugia (Astur) 2009; 20:567-570. [PMID: 19967324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropriate management, it may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.
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Affiliation(s)
- R Serramito-García
- Servicio de Neurocirugía, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Cirugía, Universidad de Santiago de Compostela.
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Paiva WS, Saad F, Carvalhal ES, De Amorim RLO, Figuereido EG, Teeixera MJ. Transorbital stab penetrating brain injury. Report of a case. Ann Ital Chir 2009; 80:463-465. [PMID: 20476680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Penetrating injury of the skull and brain is relatively uncommon, representing about 0.4% of head injuries. In this paper the Authors describe a case of patient victim of transorbital stab with brain injury with good recovery and review the literature about cranial stab wound. CASE REPORT A 23-year-old man was involved in an altercation which resulted in the patient sustaining wounds to the head, with penetrating in left transorbital, affecting the eye. At arrival to the first trauma center the patient was conscent and complete responsive with 15 points in Glasgow Coma Scale, and motor deficit grade III. CT scan demonstrated left periventricular brain hematoma and supraorbital fracture. A four-vessel cerebral angiogram demonstrated no abnormality. In this evolution patient presented good neurologic outcome. CONCLUSION In patients conscents with no surgical lesion like our patient, the hospital discharge must occur after the angiogram have excluded intracranial vascular lesion.
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Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Hospital das Clinicas University of Sao Paulo Medical School, Brazil.
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Govorun MI, Gorokhov AA, Panevich PA. [Damages of ENT-organs inflicted by the weapon of not-lethal (traumatic) action]. Voen Med Zh 2009; 330:32-37. [PMID: 20020613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There was effectuated a research of killability of traumatic weapon in laboratory as well as during analyzing of clinical observations. There were considered the results of treatment of 8 persons, suffered from traumatic weapon. It was occurred a clinical recovery by 7 wounded persons from 8. There was 1 case of lethal outcome for first hours, caused by trauma of temporal bone and cerebrum (suicide). Thus, influence of traumatic weapon on ENT-organs can be a reason of serious penetrating wounds, facial bones fracture, hematomas and contusion, formation of foreign bodies and middle ear barotraumas.
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19
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Affiliation(s)
- A Al-Anazi
- Department of Neurosurgery, King Fahad Hospital of the University, King Faisal University, Dammam, Saudi Arabia.
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20
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Abstract
The inadvertent 'plunging' of an instrument into the cranial cavity is a feared complication of drilling a burr hole and while anecdotes abound, little is known about the extent or the consequences of this problem. A survey by anonymous postal questionnaire of 304 neurosurgeons in Britain and Ireland was conducted to analyse the extent of this complication. Of respondents, 65.6% had experienced 'plunging', 22.3% having 'plunged' at least twice, indicating a high prevalence of this complication. The Cushing perforator was implicated by most. 'Plunging' carried a 12% risk of death or permanent neurological morbidity. The authors analyse the prevalence and significance of this preventable complication, and discuss various options available to minimize its occurrence.
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Affiliation(s)
- J D Caird
- Department of Neurosurgery, Regional Neurosciences Unit, Royal Victoria Hospital, Belfast, UK
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Farhadi MR, Becker M, Stippich C, Unterberg AW, Kiening KL. Transorbital penetrating head injury by a toilet brush handle. Acta Neurochir (Wien) 2009; 151:685-7. [PMID: 19255713 DOI: 10.1007/s00701-009-0221-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 02/11/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transorbital penetrating brain injuries are rare lesions without defined therapy standards. CLINICAL PRESENTATION AND INTERVENTION A male patient presented at our institution with a toilet brush handle in the right cerebral hemisphere. CT imaging identified the object entering the right orbit and having crossed the right hemisphere in the ventricular plane. After performing a medium-sized craniotomy, the object was removed step-by-step under monitoring with an intraoperative CT scan to ensure no involving major hemorrhage. CONCLUSION Transorbital penetrating brain injuries are treated best by utilizing all up-to-date technical developments such as intraoperative CT-scanning to increase the safety in the management of such exceptional lesions with increased risk of immediate life-threatening intracranial bleeding.
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Affiliation(s)
- M R Farhadi
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Cripps MW, Ereso AQ, Sadjadi J, Harken AH, Victorino GP. The number of gunshot wounds does not predict injury severity and mortality. Am Surg 2009; 75:44-48. [PMID: 19213396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
It is presumed that as the number of gunshot wounds (GSWs) increases, so do the Injury Severity Score (ISS) and mortality risk. We hypothesized that the number of bullet wounds relates to ISS and death; however, a single GSW to the head is ominous. We reviewed the charts of all GSW patients admitted to a trauma center from 2004 to 2006 (n = 531). We analyzed patient demographics, ISS, and mortality. There was no correlation with the number of GSWs with either ISS or mortality. There was only a 0.3 per cent increased risk of death for each additional GSW (r2 = 0.12). Patients with a single GSW versus multiple GSWs had no difference in mortality (9.1 vs 8.4%, P = 0.8). A single GSW to the head carried a 50 per cent mortality risk. For those who sustained both head and body GSWs, each additional GSW did not increase mortality (r2 = 0.007). Our study shows that the number of GSWs has no affect on mortality or ISS. Internal triage and management of gunshot victims should not be affected by the categorization of patients as having a single versus multiple GSWs.
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Affiliation(s)
- Michael W Cripps
- Department of Surgery, University of California San Francisco, East Bay, Alameda County Medical Center, Oakland, California 94602, USA
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Agrawal A, Malla G, Joshi S, Kumar A, Koirala S. Unusual mode of firearm injury from the recoiled rear end of a gun barrel. Singapore Med J 2008; 49:e238-e241. [PMID: 18830529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Atypical gunshot wounds are caused by a diverse set of parameters relating to weapons and ammunition. We report a previously-unreported and atypical mode of gunshot wound produced by a detached rear end of the barrel of a gun following accidental gun fire, and discuss the difficulties in the management. A 36-year-old man presented to the emergency department with an alleged history of injury on the forehead with the rear end of a gun barrel following accidental gunfire while cleaning the nozzle. Since the time of injury, the patient was in an altered sensorium and had weakness on the right side of the body. There was minimal but continuous bleeding from the wound, with extrusion of brain matter. Skull radiograph showed that the rear end of the barrel had entered the left frontal bone, with associated depressed fracture of the frontal bone. The patient underwent a bicoronal, bifrontal craniotomy with a T-shaped extension towards the barrel to facilitate the reflection of the scalp flap and to avoid any movement of the barrel as it might further injure the brain. Necrotic brain, dura and bone pieces were removed. The patient was doing well at follow-up except for mild residual motor deficits. This case illustrates that while working with limited facilities, particularly in underdeveloped countries, a careful clinical assessment, interpretation of available images and a judicious operative approach can help to save the patient.
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Affiliation(s)
- A Agrawal
- Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal.
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24
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Chan WW, Choudhari KA. Penetrating head injury caused by a dart. Ir Med J 2008; 101:255-256. [PMID: 18990959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In paediatric practice, head injury is a major public health hazard that places considerable demand on health services. It accounts for almost one third of all accidental deaths and for up to two thirds of all trauma deaths in hospital. Common house-hold objects are at times a source of penetrating head injuries in children. These include electric plugs, golf clubs, toys, nails, etc. Fortunately less than 10% of these eventually lead to permanent brain injury. We report a rare case of penetrating head injury caused by a dart.
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Affiliation(s)
- W W Chan
- Royal Hospital Belfast for Sick Children, Grosvenor Road, Belfast.
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25
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26
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Nau JY. [Susanne Zetterberg, four bullets in the head]. Rev Med Suisse 2008; 4:1180. [PMID: 18630176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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27
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Shadid O, Simpson M, Sizer J. Penetrating injury of the maxillofacial region with an arrow: an unsuccessful attempt of suicide. Br J Oral Maxillofac Surg 2008; 46:244-246. [PMID: 17561320 DOI: 10.1016/j.bjoms.2007.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2007] [Indexed: 11/20/2022]
Abstract
We present an unusual case of a penetrating injury, which was an unsuccessful attempt of suicide.
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Affiliation(s)
- Omar Shadid
- Oral & Maxillofacial Surgery Unit, Bedford Hospital NHS Trust (Beds, Herts, and Bucks OMFS Network), England, UK.
| | - Michael Simpson
- Oral & Maxillofacial Surgery Unit, Bedford Hospital NHS Trust (Beds, Herts, and Bucks OMFS Network), England, UK
| | - Jeremy Sizer
- Oral & Maxillofacial Surgery Unit, Bedford Hospital NHS Trust (Beds, Herts, and Bucks OMFS Network), England, UK
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28
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Groen AL. [Skid marks]. Ned Tijdschr Geneeskd 2008; 152:577-578. [PMID: 18402326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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29
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Tudor M, Tudor L, Tudor KI, Buca A, Cambi-Sapunar L, Carija R, Dujmović D. [Unusual open craniocerebral injury caused by sickle's tip]. Acta Med Croatica 2008; 62:85-88. [PMID: 18365507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A nine years old girl suffered an unusual penetrating injury to the head caused by a sickle's tip sticked into the skull bones during a lavender harvest on island of Hvar. GCS score was 15. A sickle's blade and its handle were clearly seen coming out of the frontal bone, hanging free, while its tip was firmly sitting in the skull bones! After a neuroradiological diagnostical work up (skull x rays and CT scans) that confirmed intracranial penetration she was operated as an emergency. An osteoclastic craniotomy was done, a and a sickle thereafter easily extracted. Lacerated and contused brain and the penetrating canal were debrided and dura defect covered with a patch. Broad spectrum antibiotics were administered after antitetanic prophylaxis. Postoperative course was uneventful especially regarding infection. One year after the accident she goes normaly to school.
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Affiliation(s)
- Mario Tudor
- Department of Neurosurgery, Split University Hospital Center, Split, Croatia.
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30
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Abstract
A case of an individual who died as a result of a self-inflicted circular saw injury to the head is presented. Death appeared to result from massive haemorrhage from injury to the superior sagittal sinus. The described mechanism of injury appears to be very unusual and may have reflected underlying issues. In particular, potential background factors resulting in the self-infliction of an injury to the head are discussed.
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Affiliation(s)
- O Judd
- Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, UK
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31
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Mamadi P, Seta W. Through-and-through penetrating spear gun injury of the head: case report. P N G Med J 2007; 50:74-76. [PMID: 19354017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Perista Mamadi
- Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province 553, Papua New Guinea
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Abstract
Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.
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MESH Headings
- Afghanistan
- Blast Injuries/epidemiology
- Blast Injuries/etiology
- Blast Injuries/rehabilitation
- Brain Injuries/epidemiology
- Brain Injuries/etiology
- Brain Injuries/rehabilitation
- Brain Injury, Chronic/epidemiology
- Brain Injury, Chronic/etiology
- Brain Injury, Chronic/rehabilitation
- Combat Disorders/epidemiology
- Combat Disorders/etiology
- Combat Disorders/rehabilitation
- Comorbidity
- Cross-Sectional Studies
- Head Injuries, Closed/epidemiology
- Head Injuries, Closed/etiology
- Head Injuries, Closed/rehabilitation
- Head Injuries, Penetrating/epidemiology
- Head Injuries, Penetrating/etiology
- Head Injuries, Penetrating/rehabilitation
- Humans
- Iraq
- Military Personnel/statistics & numerical data
- Prognosis
- United States
- Warfare
- Wounds, Gunshot/epidemiology
- Wounds, Gunshot/etiology
- Wounds, Gunshot/rehabilitation
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Affiliation(s)
- Deborah Warden
- Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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34
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Dunmade AD, Alabi BS. Penetrating injury of head and neck by the spoke of a cycle. West Afr J Med 2007; 26:55. [PMID: 17595994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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35
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Geissler K. Unusual placement of a nasogastric tube. Radiol Technol 2007; 78:253. [PMID: 17242446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Krys Geissler
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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36
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Zazpe I, Vázquez A, Beaumont C, Bardón A, Azcona J, Gallo-Ruiz A, Portillo E. [Multiple penetrating brain injuries caused by a nail gun: a case report]. Neurocirugia (Astur) 2006; 17:544-9. [PMID: 17242844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Multiple and self-inflicted penetrating brain injuries (PBI) rare. PBI are rare. We report the case of multiple self-inflicted PBI in a 45 year old man caused by a nail gun. He was admitted to after shooting four nails into his head and one into his thorax. We review the literature on the topic and describe how this case was successfully managed in our hospital.
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Affiliation(s)
- I Zazpe
- Servicios de Neurocirugía. Hospital de Navarra
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Calvo-Rubal A, Martínez F, Tarigo A. [Cranial wounds of the skull caused by a fencing-foil]. Neurocirugia (Astur) 2006; 17:550-4. [PMID: 17242845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Penetrating stab cranial wounds of the skull by fencing-foil are rare in western countries. CASE REPORT This 46-year-old man suffered a penetrating stab wound of the skull through the right orbital region. As a consequence he developed an intracranial hematoma requiring surgical evacuation. DISCUSSION AND CONCLUSIONS Damage of intracranial contents due to transorbital penetrating objects other than missiles is a rare event.
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MESH Headings
- Acute Disease
- Adult
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Arteriovenous Fistula/diagnostic imaging
- Arteriovenous Fistula/etiology
- Athletic Injuries/diagnostic imaging
- Athletic Injuries/etiology
- Athletic Injuries/surgery
- Brain Injuries/etiology
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Cerebral Angiography
- Consciousness Disorders/etiology
- Craniotomy
- Exophthalmos/etiology
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/etiology
- Head Injuries, Penetrating/surgery
- Headache/etiology
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/etiology
- Hematoma, Subdural/surgery
- Humans
- Male
- Middle Aged
- Ophthalmoplegia/etiology
- Orbital Fractures/diagnostic imaging
- Orbital Fractures/etiology
- Skull Fractures/diagnostic imaging
- Skull Fractures/etiology
- Sphenoid Bone/injuries
- Stents
- Tomography, X-Ray Computed
- Vision Disorders/etiology
- Vomiting/etiology
- Wounds, Stab/diagnostic imaging
- Wounds, Stab/etiology
- Wounds, Stab/surgery
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Affiliation(s)
- A Calvo-Rubal
- Servicio de Neurocirugía del Hospital Maciel. Ministerio de Salud Pública. Montevideo. Uruguay
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38
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Bjornsson CS, Oh SJ, Al-Kofahi YA, Lim YJ, Smith KL, Turner JN, De S, Roysam B, Shain W, Kim SJ. Effects of insertion conditions on tissue strain and vascular damage during neuroprosthetic device insertion. J Neural Eng 2006; 3:196-207. [PMID: 16921203 DOI: 10.1088/1741-2560/3/3/002] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Long-term integration of neuroprosthetic devices is challenged by reactive responses that compromise the brain-device interface. The contribution of physical insertion parameters to immediate damage is not well described. We have developed an ex vivo preparation to capture real-time images of tissue deformation during device insertion using thick tissue slices from rat brains prepared with fluorescently labeled vasculature. Qualitative and quantitative assessments of damage were made for insertions using devices with different tip shapes inserted at different speeds. Direct damage to the vasculature included severing, rupturing and dragging, and was often observed several hundred micrometers from the insertion site. Slower insertions generally resulted in more vascular damage. Cortical surface features greatly affected insertion success; insertions attempted through pial blood vessels resulted in severe tissue compression. Automated image analysis techniques were developed to quantify tissue deformation and calculate mean effective strain. Quantitative measures demonstrated that, within the range of experimental conditions studied, faster insertion of sharp devices resulted in lower mean effective strain. Variability within each insertion condition indicates that multiple biological factors may influence insertion success. Multiple biological factors may contribute to tissue distortion, thus a wide variability was observed among insertions made under the same conditions.
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Affiliation(s)
- C S Bjornsson
- Laboratory of Nervous System Disorders, Wadsworth Center, New York State Department of Health, Albany, NY 12201-0509, USA
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39
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Abstract
During a dispute, a boy was injured by a curtain rail which penetrated the skull in the left frontal region and led to severe brain injury. Despite intensive medical care, death occurred 10 days later due to malignant cerebral edema. With regard to the question whether the trauma resulted from throwing or pushing, some biomechanical aspects are discussed including individual morphologic findings as well as the kinetic energy required for penetrating the skull. According to the calculated data, we conclude that the velocity necessary for penetrating could be reached by throwing the curtain rail.
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Affiliation(s)
- A Lauterbach
- Department of Legal Medicine, University of Erlangen-Nuremberg, Universitätsstrasse 22, 91054 Erlangen, Germany.
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40
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Muzumdar D, Higgins MJ, Ventureyra ECG. Intrauterine penetrating direct fetal head trauma following gunshot injury: a case report and review of the literature. Childs Nerv Syst 2006; 22:398-402. [PMID: 16096718 DOI: 10.1007/s00381-005-1200-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Indexed: 11/28/2022]
Abstract
CASE REPORT An unusual case of an intrauterine penetrating head injury due to a pellet from an airgun is described. A 28-year-old pregnant woman, at term, shot herself intravaginally with a toy BB gun. Following a spontaneous precipitous vaginal delivery, the neonate presented with persistent seizure disorder, meningitis, cerebritis, and a right parietal region scalp swelling. Imaging studies revealed intracranial hemorrhage, and the metallic pellet was adjacent to the right lateral ventricle, which was removed through a parietal craniotomy. Computed tomography of the brain after 1 week demonstrated early abscess formation in the left frontal operculum and a subdural empyema in the posterior fossa. The abscesses were evacuated, and the meningitis was treated vigorously with broad-spectrum antibiotics. Although well for the past 6 years, the child demonstrates significant mental handicap and developmental delay. DISCUSSION The pathogenesis, management, and medicolegal issues pertaining to the above case are discussed, and the relevant literature is briefly reviewed.
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Affiliation(s)
- Dattatraya Muzumdar
- Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8 L1, Canada
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41
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Iskhakov OS, Potapov AA, Shipilevskiĭ VM. [Relationship of the mechanism of injury to the types of brains damage and outcomes in children with isolated and mixed brain injury]. Zh Vopr Neirokhir Im N N Burdenko 2006:26-31; discussion 31. [PMID: 16827426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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42
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Abstract
Transcranial stab wounds are uncommon among both adults and adolescents and rarely occur in children, particularly when caused by another child. A 20-month-old girl was injured by a 3-year-old cousin, who introduced a knife blade into the brain through the left parietal region. The trajectory of the wound penetrated at least 5 cm, crossed the falx cerebri, and involved both motor cortical areas. The clinical sequela was a severe symmetric spastic diplegia.
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43
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López González A, Gutiérrez Marín A, Alvarez Garijo JA, Vila Mengual M. Penetrating head injury in a paediatric patient caused by an electrical plug. Childs Nerv Syst 2006; 22:197-200. [PMID: 15928968 DOI: 10.1007/s00381-005-1141-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Penetrating head injuries are rare especially in the paediatric age group. Relatively minor falls over common household objects can cause potentially life-threatening brain injuries. CASE REPORT We describe a penetrating head injury caused by a household electrical plug in a 6-month-old child. The two rounded pins of the plug were embedded in the posterior parietal area of her head, very close to the cranial midline. There was no neurological deterioration or bleeding. Radiological investigation showed a depressed skull fracture underneath the two pins. One of them came very close to the superior sagittal sinus but there was no evidence of intracranial bleeding. The electrical plug was extracted under general anaesthesia in the operating theatre. The penetrating fracture segments were removed. The sagittal venous sinus was fortunately undamaged. CONCLUSIONS Household objects like electrical plugs may constitute a risk for children. It may be worthwhile to reconsider the design of electrical plugs.
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Affiliation(s)
- Antonio López González
- Department of Neurosurgery, Hospital Universitario La Fe, Avenida Campanar, 21, 46009, Valencia, Spain.
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44
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Park SH, Cho KH, Shin YS, Kim SH, Ahn YH, Cho KG, Yoon SH. Penetrating craniofacial injuries in children with wooden and metal chopsticks. Pediatr Neurosurg 2006; 42:138-46. [PMID: 16636613 DOI: 10.1159/000091855] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 08/18/2005] [Indexed: 11/19/2022]
Abstract
Penetrating craniofacial injuries with chopsticks in children are peculiar accidents in the Oriental culture. All 10 cases previously reported were caused by wooden chopsticks that required surgical operations. However, there are no reported injuries with metal chopsticks in the past literature which should have been as common as that of wooden chopstick injuries in Asia. We evaluated the difference of injury patterns and clinical observations between wooden and metal chopstick injuries. We reviewed 6 treated children with penetrating craniofacial injuries from chopsticks: one wooden and five metal chopsticks. One child who had penetration through the nasal cavity presented with temporary rhinorrhea, another with mild hemiparesis, and one child with temporary upward gaze limitation of the left eye. Radiological examination revealed 1 patient with epidural hemorrhage, 1 patient with minimal subdural hemorrhage, and 4 with intracerebral hemorrhage that were fortunately too small to receive surgery. We performed surgical procedure only for a child who had a wooden chopstick that had impacted into the temporal cortex. We followed up all 6 children for more than 1 year, and found that all had fully recovered to near-normal neurological status. We observed that penetrating craniofacial injuries with metal chopsticks rarely require surgical intervention and usually results in good outcome because the resultant wound is usually small without broken fragments compared to injuries with wooden chopsticks.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Craniotomy
- Cross-Sectional Studies
- Eye Injuries, Penetrating/epidemiology
- Eye Injuries, Penetrating/etiology
- Eye Injuries, Penetrating/surgery
- Facial Injuries/epidemiology
- Facial Injuries/etiology
- Facial Injuries/surgery
- Female
- Foreign Bodies/epidemiology
- Foreign Bodies/etiology
- Foreign Bodies/surgery
- Head Injuries, Penetrating/epidemiology
- Head Injuries, Penetrating/etiology
- Head Injuries, Penetrating/surgery
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Incidence
- Infant
- Korea
- Magnetic Resonance Imaging
- Male
- Metals
- Orbit/injuries
- Orbit/pathology
- Skull Fractures/epidemiology
- Skull Fractures/etiology
- Skull Fractures/surgery
- Tomography, X-Ray Computed
- Wood
- Wounds, Penetrating/epidemiology
- Wounds, Penetrating/etiology
- Wounds, Penetrating/surgery
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Affiliation(s)
- Se-Hyuck Park
- Department of Neurosurgery, Kandong Sacred Heart Hospital, Hallym University, Seoul, Korea
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45
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Kumar A, Singh H, Sharma KC. Penetrating head injury from a pedestal fan rotor blade in a child - an unusual case. Pediatr Neurosurg 2006; 42:391-4. [PMID: 17047422 DOI: 10.1159/000095572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 01/23/2006] [Indexed: 11/19/2022]
Abstract
Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in casualty. A number of household articles have been described to cause penetrating injuries, apart from gunshot and pellet injuries. We describe, for the first time, an unusual case of penetrating injury due to the rotor blade of pedestal fan used very commonly in the Indian subcontinent.
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Affiliation(s)
- Arun Kumar
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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46
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Affiliation(s)
- P Leach
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Hospital Road, Pendlebury, Manchester, USA.
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47
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Murano T, Mohr AM, Lavery RF, Lynch C, Homnick AT, Livingston DH. Civilian craniocerebral gunshot wounds: an update in predicting outcomes. Am Surg 2005; 71:1009-14. [PMID: 16447469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Given the high mortality in patients sustaining intracranial injury secondary to gunshot wounds (GSWs), predictors to identify patients at increased risk of death are needed to assist clinicians early in determining optimal treatment. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients, which do not allow for adequate prediction of mortality. A retrospective chart review of 298 patients who sustained GSWs to the head between 1992 and 2003 was conducted at a level 1 trauma center. Demographics, bullet trajectory, admitting Glasgow Coma Scale (GCS), head Abbreviated Injury Score (AIS), as well as admission blood pressure and respiratory rate were evaluated. Univariate testing followed by multivariate logistic regression was performed to identify independent predictors of death. In-hospital mortality for patients with intracranial injury secondary to GSW was 51 per cent. A GCS <5 on admission and a high Injury Severity Score (ISS >25) was associated with mortality as compared with survivors (P < 0.05). Of those patients presenting with a GCS of 3, there were seven survivors to discharge. Logistic regression identified the following variables as predictors of death: respiratory arrest on admission, hypotension on admission, transhemispheric and transventricular GSW. Identification of those patients at the highest risk of death secondary to a craniocerebral GSW allows clinicians to better predict outcome and prognosis. This is not only important in determining treatment algorithms for physicians but also for appropriate counseling of family members to educate them with regard to patients' outcomes.
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Affiliation(s)
- Tiffany Murano
- Department of Surgery, Division of Emergency Medicine, UMDNJ-New Jersey Medical School, Newark, New Jersey 07103, USA
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48
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Healey DL, Kieser JA. Unusual fatal dog attack in Dunedin, New Zealand. J Forensic Odontostomatol 2005; 23:51-4. [PMID: 16353756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A case of a fatal dog attack on a middle aged woman is presented. The offending dog was her own Bull-mastiff, which had previously shown signs of aggression towards her. Most of the injuries were found on the victim's face, neck and skull. A noteworthy feature of this attack was that the victim was known to suffer from Huntington disease. It is postulated that the involuntary movements, progressive dementia and increased moodiness characteristic of the disease may have had a significant role in triggering the attack.
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Affiliation(s)
- D L Healey
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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49
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Isakov VD, Babakhanian AP, Tamberg DK. [Injuries inflicted by non-barrel self-defense guns]. Sud Med Ekspert 2005; 48:32-4. [PMID: 16130332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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50
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Affiliation(s)
- F U Ahmad
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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