An Unusual Missile-Type Head Injury Caused by a Stone

Low-velocity penetrating brain injury: a review of the literature and illustrative case

INTRODUCTION

Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied.

CASE

As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness.

DISCUSSION

Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course.

CONCLUSION

In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes.

Two case reports of fatal injuries sustained from tear gas guns loaded with pebbles as missiles

These two case reports are of fatal injuries from less-lethal weapons (tear gas guns) using pebbles as an unconventional ammunition. Reported here are the fatal outcomes of two 19-year-old males, one with head trauma and the other with abdominal trauma. They were admitted to the ED and subjected to immediate exploratory operations, but they passed away. On autopsy, the first case demonstrated a right frontal bone fracture with subdural hemorrhage and a 3 × 2.5 cm pebble retained in the skull. The second case showed severe liver laceration in close vicinity to a cubical pebble (3.2 × 3 cm). The mechanical forces involved in skull fracture and autopsy are discussed. In the current cases, the relatively larger weight and size together with the surface configuration of the pebble projectile were the main influential factors that contributed to the severity of damage and fatality.These case reports are a working example of the effect of the mass of projectiles in increasing the power of penetration. The direct shooting to the head and the abdomen together with the misuse of these weapons are capable of inflicting fatal injuries.

Antemortem trauma and survival in the late Middle Pleistocene human cranium from Maba, South China

Paleopathological assessment of the late Middle Pleistocene archaic human cranium from Maba, South China, has documented a right frontal squamous exocranially concave and ridged lesion with endocranial protrusion. Differential diagnosis indicates that it resulted from localized blunt force trauma, due to an accident or, more probably, interhuman aggression. As such it joins a small sample of pre-last glacial maximum Pleistocene human remains with probable evidence of humanly induced trauma. Its remodeled condition also indicates survival of a serious pathological condition, a circumstance that is increasingly documented for archaic and modern Homo through the Pleistocene.

Continuity of interpersonal violence between Nubian communities

Modern communities affiliated with the same culture have been shown to experience comparable levels of interpersonal violence, no matter what their size. It was hypothesized that a similar relationship would exist among ancient rural and urban people, but that accident-related trauma may be more prominent among rural dwellers due to their activity base. Through an analysis of antemortem trauma, this investigation contrasted the injury profile of Nubian adult villagers (N = 55) from the Kerma period (2500-1750 BC) to that of their urban neighbors (N = 223) at Kerma (2050-1500 BC). The injury pattern associated with interpersonal violence (cranial injury, direct-force ulna fractures, and multiple injuries) was similar between the two samples, as hypothesized. The rural group sustained significantly more nonviolence-related injuries that suggested occupational or environmental influences. The more severe cranial injuries observed among urban people are attributed to a preference for more lethal hand-wielded objects that may have accompanied increasing local tensions and incursions into Egypt during the 17th Dynasty.