Silent orbitocranial penetration by a pencil

Intracranial Migration of a Broken Rod After Orbitocranial Injury in an Adult

BACKGROUND

Craniocerebral injuries due to the induction of sharp objects are relatively rare and are nearly always observed in the pediatric rather than the adult population. Orbitocranial injuries involving a piece of smooth steel rod are extremely rare and to our knowledge have yet to be reported in previous publications. When this particular category of injury does occur, the invading intracranial foreign body usually remains lodged within its entry position. This is most often near the entry point and within the frontal lobe after penetrating the orbit. Migration of the penetrating object far from the initial entry point is quite rare and has been historically confined to low-velocity bullet wounds.

CASE DESCRIPTION

An adult man was injured on the right eyelid by a section of steel rod. The rod had entered the cranium through the right orbital roof and was lodged within the corresponding right frontal lobe. An initial plain radiograph showed that the rod was within the right frontal lobe. However, computed tomographic angiography of the brain performed during the second day of admission demonstrated displacement of the rod to the left hemisphere. This finding was clearly demonstrated through subsequent imaging. As a result of the migration, the rod could be distracted fairly easily through a left parasagittal and interhemispheric approach. Postoperatively, the patient made a full recovery.

CONCLUSIONS

Migration of traumatically introduced intracranial foreign bodies far from their initial entry places should be suspected in objects possessing sufficient weight and a smooth surface. This means that a correct assessment of the final position of such objects is necessary before surgery, even while the patient is on the operating table.

Penetrating Orbital Injuries: A Review

Penetrating injuries to the orbit represent a small but very complicated portion of head injuries. Because of the close proximity to many vital structures, any penetrating orbital injury requires a multidisciplinary follow-up. Cases of penetrating injuries have flooded the literature, but no one has presented a systematic approach to the complications associated with these types of injuries. Herein, we present the complications associated with each orbital entry mode: superior, inferior, medial, lateral rims of the orbit, and extraorbital entry.

Pencils and Pens: An Under-Recognized Source of Penetrating Injuries in Children

Unlike other sharp objects, pens and pencils are readily available to children both at home and school. Although case reports are published, no series of pen or pencil injuries have been reported in the recent literature. We therefore reviewed the incidence and injury profiles of writing instruments as compared with other sources of penetrating trauma. The trauma registry from a large urban pediatric hospital system was queried for nonmissile, nonbite penetrating injuries from 2005 through 2009. Retrospective data was collected on demographics, injuries, operations, admissions, and mortalities. Additionally, data regarding pen and pencil injuries from 2009 to 2010 were collected prospectively, and one case from 2003 was included retrospectively. Fourteen injuries from writing instruments were seen and involved the head and neck (9), chest (1), bladder/perineum (2), and extremities (2). Eleven children were admitted and eight required surgical intervention. One child died from a transhemispheric brain injury after intraorbital penetration by a pencil. Penetrating trauma from writing instruments is not an uncommon source of injury and often requires surgical intervention to remove the object. Injuries from pens and pencils can be severe or even fatal. Appropriate parent and teacher education regarding the potential risks may help to prevent such injuries.

Occult Perforating Corneal Injury from Mechanical Pencil Graphite

An 11-year-old boy was struck in the left eye with a mechanical pencil in a projectile manner. Initial examination under the operating microscope revealed a presumed partial-thickness corneal injury with a retained 8-mm long segment of graphite lead. After removal of the graphite segment, a full-thickness hole in the cornea was revealed under the lead shaft. The proposed mechanism of injury and unique presentation was initial full-thickness penetration followed by lead shaft retraction (likely due to eye rubbing) and then corneal stromal reentry with stromal lamellar dissection and fixation. Prompt removal of the foreign body, corneal laceration repair, and early cataract extraction resulted in postoperative 20/40 uncorrected visual acuity. Mechanical lead pencil injuries represent a unique mechanism of penetrating trauma.

Perforating eyelid injury extending to the brain stem in a 17-year-old woman: a case report

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.

Near lethal art--transorbital brain injury

Penetrative transorbital injuries put intracranial structures in peril. We present one such case where a low velocity transorbital injury resulted in traumatic temporal lobe injury, but with full recovery. Clinicians should be vigilant of intracranial complications of transorbital injuries.

Penetrating head injury in a paediatric patient caused by an electrical plug

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.