Unusual transoral penetrating injury of the foramen magnum: case report

A Rare Case of Craniocervical Penetrating Injury by a Steel Bar

Rationale

Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery.

Chief Complaint

The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability.

Diagnosis

Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue.

Intervention

We successfully performed the operation and removed the steel bar.

Outcomes

The patient was followed up for 5 years; muscle strength returned to normal.

Lessons

Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.

Imaging foreign bodies in head and neck trauma: a pictorial review

Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered.

Here, we would like to give a practical radiological guide for the assessment of foreign objects in head and neck injuries by a special selection of patients with different injury patterns and various foreign body materials with regard to the present literature.

A Recreational Fishing Death Due to a Jumping Spanish Mackerel (Scomberomorus commerson)

Commercial or recreational fishing may be associated with a wide range of potentially lethal events. We report the case of a 56-year-old man who died of blunt force chest and abdominal trauma after impact with a large Spanish mackerel (Scomberomorus commerson) that had jumped into his recreational fishing boat. Injuries at autopsy included soft tissue bruising with fractured ribs, a ruptured diaphragm, intestinal and mesenteric contusions, contusion and disruption of the pancreas, and hilar splenic lacerations with a left-sided hemothorax and a hematoperitoneum. The clear temporal association of pain and progressive deterioration leading to cardiac arrest after the impact indicated that lethal injuries had been sustained. A variety of fish and cetacean species are known to jump out of the water sometimes to escape predators. It was reported that a large number of jumping fish being pursued by sharks were observed in the harbor on the day of the reported incident. This case demonstrates that lethal blunt abdominothoracic trauma may be caused by impact with Spanish mackerel, increasing the range of potentially dangerous situations that may be encountered while fishing.

A transnasal foreign body penetrating the spinal cord from the nasopharynx

OBJECTIVE AND IMPORTANCE

This is the first article regarding a transnasal Foreign bodies (FB) penetrating the spinal cord. We tried to remove it safely with a bilateral approach by performing a nasal endoscopy and partial laminectomy.

CLINICAL PRESENTATION

During logging work, a tree hit the occipital region of a 47-year-old man, producing unconsciousness with left paresis. Although he did not remember his injuries due to traumatic amnesia, a computed tomography (CT) scan showed a metal rod lodged from the left side wall of the nasopharynx to the spinal column at the cranial-cervical transition.

INTERVENTION

A C1 laminectomy, partial occipital bone resection, and endoscopic intranasal extirpation were done jointly by an otolaryngologist and neurosurgeon under general anesthesia to safely remove the FB. All procedures were performed in the right lateral decubitus position so we could approach both the nasopharynx and occipital sides. The otolaryngologist withdrew the FB from the nasal cavity using an endoscope while the neurosurgeon monitored the occipital bone side. The FB was safely removed.

CONCLUSION

The site of penetration at the nasopharynx contracted gradually to a scar with no cerebrospinal fluid (CSF) leak. The patient was finally discharged 39 days after surgery with no motor/sensory paralysis.

Penetrating head trauma: 03 rare cases and literature review

Penetrating head trauma (PHT) include all open head injuries with foreign object in the brain. Although less common than closed head trauma, penetrating head trauma carry a worse prognosis. We received three unusual cases of penetrating head injuries whose prognosis was different according to clinical presentation and initial management of the patient. Treatment of penetrating head trauma aims at controlling bleeding, controlling intracranial pressure and preventing infections. Despite the efforts made by national authorities as well as the adequate management in hospitals, penetrating head injuries are still frequent with significant mortality and morbidity.

Surviving Penetrating Brainstem Injury by Bamboo Sticks: Rare Case Reports and a Brief Review of Literature

BACKGROUND AND IMPORTANCE

Chopsticks are common utensils used in many Asian cultures. However, they sometimes can be used as weapons or can cause accidents, particularly in children. Penetrating transorbital/transpharyngeal intracranial injuries with bamboo sticks are peculiar accidents and are relatively rare. Because of their rarity, the management of such injuries is often complex. We discuss 3 cases of penetration of the brainstem by bamboo sticks, 1 case through the foramen magnum, which, to the best of our knowledge, is the first reported case of such an injury.

CLINICAL PRESENTATION

The case of a 50-year-old man who was stabbed with a pair of chopsticks in his left eye is presented. The chopsticks passed through the cavernous sinus, and the patient sustained superior orbital fissure syndrome. The other 2 cases were those of a 4-year-old girl having a similar pattern but different mechanism of injury and a 2-year-old boy who sustained transpharyngeal intracranial injury via the foramen magnum. Computed tomography, magnetic resonance imaging, and computed tomographic angiography (CTA) are the key imaging modalities frequently used to determine the course and extent of brain injury.

CONCLUSION

Early surgical exploration by a multidisciplinary team approach is essential for attaining a favorable outcome. All cases demonstrated good postoperative recovery and were successfully managed by removing the foreign body through its trajectory. We discuss and briefly review the literature on patterns, complications, and management issues of these less common injuries.

Penetrating injury of the upper cervical spine by a chopstick--case report

A 35-year-old man presented with penetrating spinal injury after attempting suicide by stabbing a wooden chopstick into his mouth. The object penetrated the pharynx, and the tip entered the spinal canal of the atlantoaxial vertebrae. Emergent surgery disclosed that the tip of the chopstick had penetrated between the dural sac and the vertebral artery. There was no dural tear or vertebral artery injury. The foreign body was removed successfully from the oral side. He recovered without neurological sequelae.