A Case of Intracranial Wooden Foreign Body: Mimicking Pneumocephalus

Brain abscess due to clostridium celerecrescens: first report and literature review

BACKGROUND

Brain abscess caused by atypical pathogens presents significant diagnostic and therapeutic challenges. The unusual clinical presentations, coupled with incomplete or inaccurate patient histories, often result in misdiagnosis and inappropriate treatment.

CASE PRESENTATION

We report a case of a retained intracranial bamboo foreign body resulting in a brain abscess. A female adolescent presented with a newly developed mass on the eyelid. Medical imaging identified a foreign body that had penetrated the frontal lobes via the transorbital route, leading to the formation of a brain abscess. The foreign body was successfully removed through transnasal endoscopy. Inflamed tissue adherent to the foreign body was cultured and analyzed using metagenomic next-generation sequencing (mNGS), which identified Clostridium celerecrescens as the causative pathogen. The patient fully recovered after surgical debridement and two weeks of antibiotic therapy.

CONCLUSIONS

Infections caused by C. celerecrescens are exceedingly rare in clinical practice. This case highlights the bacterium's ability to adhere to a bamboo foreign body, leading to the formation of a rare brain abscess. mNGS proves to be a valuable diagnostic tool for identifying uncommon infectious agents.

Penetrating Neck Injury Involving Wooden Foreign Bodies: Case Report

Although rare, penetrating neck injuries can have grave consequences, and are associated with high mortality rates. Individuals with cervical injuries due to wooden foreign bodies are at an increased risk of developing infectious complications. In this case, a male patient aged 27 years presented with a cervical injury indicative of a penetrating wound caused by a wooden foreign body. Computed tomography (CT) scan revealed no signs of intracranial hemorrhage or fracture. Additionally, cervical CT scan showed no evidence of cervical corpus or longus colli muscle lesions. The medical team suggested a cervical magnetic resonance imaging (MRI) examination; however, the patient's family opted out. Subsequently, the patient underwent wound debridement, which involved the extraction of a fragment of impaling wood. Two days after the procedure, the patient developed a fever and weakness of the shoulder and arm on the ipsilateral side. Following the process of re-education, the family provided consent for MRI examination. A subsequent surgical procedure was performed on the patient based on the MRI findings and clinical presentation. Residual wooden fragments were effectively extracted, resulting in positive progression of the patient's condition.

Minimally Invasive Subtemporal Intradural Approach for Penetrating Orbitocranial Injury by Wooden Foreign Body Into the Lateral Wall of the Cavernous Sinus

Non-missile transorbital penetrating head injuries are relatively rare, though potentially fatal injuries. Trajectory for intracranial entrance is typically via the orbital roof, the superior orbital fissure (SOF), or the optic canal. Non-metallic intracranial penetrating injuries are even scarcer and may pose unusual diagnostic and surgical challenges. Here we present and discuss a unique case of a penetrating injury by a wooden foreign body (FB) which entered and expanded the inter-dural space of the lateral cavernous sinus (CS) sinus wall without intracavernous or intradural involvement. The patient was a 71 year-old male who fell face-down and sustained a penetrating transorbital injury by a dry twig fragment, which passed through the SOF and into the interdural space of lateral wall of the ipsilateral CS. The patient was fully conscious (GCS15) at presentation but had severe ocular injury (complete ophthalmoplegia and blindness of the injured eye). The wooden FB was successfully removed via a minimally invasive subtemporal intradural approach with no apparent immediate or long-term complications. We emphasize the unusual diagnostic and surgical challenges related to this kind of rare injuries as reflected by the decision-making considerations taken in the presented case.

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.

Traumatic Optic Neuropathy and Monocular Blindness following Transnasal Penetrating Optic Canal Injury by a Wooden Foreign Body

Purpose

To report a case of right eye blindness due to a penetrating injury in the contralateral nostril.

Methods

This is a case report of a 67-year-old patient who presented to the emergency room complaining of transient blurred vision in his right eye after falling on a small branch with no apparent injury besides minor lacerations. The following day, the patient experienced blindness in the right eye. Physical examination revealed small lacerations on his left forehead and optic neuropathy on the right side with no other obvious discerning physical or imaging abnormalities.

Results

After elevated suspicion and reassessment of the neuroimaging findings, a radiolucent track was observed in the nasal cavity, continuing up from the left nostril to the right optic nerve. Transnasal endoscopic surgery was performed and a long wooden branch was removed from the nasal cavity.

Conclusion

A nasally penetrating wooden foreign body can cause traumatic optic neuropathy and vision loss on the unaffected side and can be very difficult to locate and image without any clear external evidence as to its presence. This case highlights the importance of maintaining a high level of suspicion in these types of cases.