Intracranial metallic foreign bodies in a man with a headache

Unidentified Intracranial Foreign Body in an Epileptic Child: Infanticide or Child Abuse?

Although intracranial foreign bodies are typically associated with penetrating injuries or surgical interventions, they can also occur as a result of rare instances of child abuse. Enduring such abuse and neglect as an infant can lead to life-long neurological problems, developmental delays, and impairments. The present case involved a 14-year-old male adolescent who was brought to the emergency room due to recurrent generalized tonic seizures. A computed tomography (CT) scan revealed a ring-like metallic object within the right temporal lobe. The neurosurgeon declined the surgical removal of the object due to its position and orientation, as well as the patient's guardian's refusal to consent to surgery. Instead, drug treatment and care are advised. In infants, foreign objects are typically inserted through cranial sutures, fontanelles and less frequently into the orbits, often with the intention of harming unwanted children. However, no history of such an attempt is present in this case. The incidental discovery of intracranial foreign bodies typically occurs during investigations when patients present with neurological symptoms such as epileptic seizures (foreign body-induced epilepsy). The selection of an ideal treatment regimen is often challenging in such cases. If a patient can be effectively treated with drugs, surgical removal is usually avoided.

The Safety of Micro-Implants for the Brain

Technological advancements in electronics and micromachining now allow the development of discrete wireless brain implantable micro-devices. Applications of such devices include stimulation or sensing and could enable direct placement near regions of interest within the brain without the need for electrode leads or separate battery compartments that are at increased risk of breakage and infection. Clinical use of leadless brain implants is accompanied by novel risks, such as migration of the implant. Additionally, the encapsulation material of the implants plays an important role in mitigating unwanted tissue reactions. These risks have the potential to cause harm or reduce the service of life of the implant. In the present study, we have assessed post-implantation tissue reaction and migration of borosilicate glass-encapsulated micro-implants within the cortex of the brain. Twenty borosilicate glass-encapsulated devices (2 × 3.5 × 20 mm) were implanted into the parenchyma of 10 sheep for 6 months. Radiographs were taken directly post-surgery and at 3 and 6 months. Subsequently, sheep were euthanized, and GFAP and IBA-1 histological analysis was performed. The migration of the implants was tracked by reference to two stainless steel screws placed in the skull. We found no significant difference in fluoroscopy intensity of GFAP and a small difference in IBA-1 between implanted tissue and control. There was no glial scar formation found at the site of the implant’s track wall. Furthermore, we observed movement of up to 4.6 mm in a subset of implants in the first 3 months of implantation and no movement in any implant during the 3–6-month period of implantation. Subsequent histological analysis revealed no evidence of a migration track or tissue damage. We conclude that the implantation of this discrete micro-implant within the brain does not present additional risk due to migration.

An Asymptomatic Intracranial Foreign Body in a Child as a Result of Unintentional Firearm Injury

Aerial firing is often used as a form of riot control, but also in certain parts of the world as a celebratory act, often resulting in unintentional injury and/or death. It is uncommon for a patient to walk into an emergency room, seemingly comfortable, only to discover an intracranial foreign body. We report a case of a child who was struck by a stray bullet that pierced his skull through a small entry wound and lodged itself in the falx cerebri. The patient remained asymptomatic and no intervention was required. We wish to highlight the importance of imaging techniques in patients with small wounds who are otherwise asymptomatic as well as point out the salient features regarding stray bullet injuries.

Surgical removal of a sewing needle penetrated through the foramen lacerum into a canine brain

An intracranial metallic foreign body (sewing needle) was diagnosed in an 11-month-old Cavalier King Charles Spaniel. Clinical evaluation showed drooling and chewing, but an otherwise normal neurological examination. Skull radiographs showed a metallic foreign body extending from the pharynx into the skull. A CT scan confirmed the presence of a foreign body crossing the right foramen lacerum into the brain. The needle was removed surgically with the aid of fluoroscopy.

A late onset adult seizure due to intracerebral needle: case-based update

BACKGROUND AND AIM

Late-onset seizure due to intracerebral needle is a rare entity. Most of them were clinically asymptomatic and rarely presented with seizure. Sewing needles are used in homicidal attempt in infancy or early childhood before the closure of the fontanels. Because of sociologic, politic, and scientific deficiencies subject remained untouched. We tried shedding some light on this ambiguous phenomenon.

MATERIAL AND METHODS

We report a 54-year-old man who was admitted to our neurosurgery outpatient department with epilepsy due to a sewing needle located in the left frontal lobe of the brain and made extensive literature review.

RESULT

Patient's physical and neurological examinations were completely normal. All biochemical and hematological tests were normal. Cranial tomography demonstrated a linear density at the left frontal lobe compatible with a sewing needle. Patient was followed-up with antiepileptic treatment with no seizure. Sixty cases from up-to-date literature and past cases were reviewed. Patients' ages differ from 4 days to 70 years. Our review showed four cases treated with antibiotics, 19 patients went to surgery, and others just followed-up with antiepileptic and other drugs.

CONCLUSION

Literature needs an autopsy series for a more intimate estimation. Due to psychosocial and legitimacy problems, matter should be handled cautiously and law enforcement agencies must be informed. Follow-up with medication is the first line of treatment with asymptomatic patients. Treatment is dictated by clinic onset, physical examination, and patient consent.

Asymptomatic Intracranial Foreign Body: An Incidental Finding on Radiography

Introduction

Intracranial needles are rare entities. Intracranial foreign bodies due to non-missile intracranial penetrations are one of the most rarely encountered situations in neurosurgery. Sewing needles are among the more unusual foreign bodies that may be found in the brain. Although uncommon, foreign body cases are important and interesting. Foreign bodies enter the body through trauma or iatrogenic injuries. Needles are mostly inserted through fontanelles, cranial sutures, and more rarely through the orbits in infancy for the purpose of killing unwanted babies.

Case Presentation

This article presents a case of intracranial foreign body found upon radiography. A 24-year-old female, who two days prior to presentation suffered only once from dizziness, and was otherwise healthy.

Conclusions

Because this incident may have occurred during the patient’s neonatal period, it may be a case of child abuse. In spite of the very limited number of cases in the literature, having a stepmother, a stepfather, or a babysitter, being the youngest child, or having family members who suffer from psychiatric disorders, (especially if these relatives are responsible for child care), living in a society that allows homicide of children born from extramarital relationships, and being female have been suggested as possible risk factors.

Symptomatic migration of a Kirschner wire into the spinal canal without spinal cord injury: case report

The migration of Kirschner wires (K-wires) is a rare but significant complication of osteosynthesis interventions, and numerous cases of wire migrations have been reported in the literature. Nevertheless, migration into the spinal canal is very rare, with only 10 cases reported thus far. The authors present a case of K-wire migration into the spinal canal, together with a review of the relevant literature.

A 30-year-old male who had suffered a right clavicle fracture in a motorcycle accident was treated with 2 K-wires. Four months after the initial fixation, while he was lifting his child, he experienced short-term pain in his back, numbness in all 4 extremities, followed by a spontaneous decrease in numbness affecting only the ulnar nerve dermatomes bilaterally, and a persistent headache. No urinary incontinence was present.

Simple radiography studies of the cervical spine revealed a wire in the spinal canal, penetrating the T-2 foramen and reaching the contralateral foramen of the same vertebra. Computerized tomography showed the wire positioned in front of the spinal cord. Surgery for wire extraction was performed with the patient under general anesthesia, and he experienced relief of the symptoms immediately after surgery.

This case is unique because the wire caused no damage to the spinal cord but did cause compression-related symptomatology and headache, which have not been reported in osteosynthesis wire migration to the thoracic region.

Migration of a sewing needle foreign body into the brainstem of a cat

CASE SUMMARY

A 1-year-old, female spayed domestic shorthair cat with a 6 week history of upper respiratory signs and a progressive reluctance to move, which culminated in a right-sided hemiparesis, was found to have a sewing needle foreign body lodged in the brainstem. Surgical extraction of the needle was successful and the cat's neurological deficits resolved over the days to weeks following its removal.

RELEVANCE AND NOVEL INFORMATION

This case report describes, to our knowledge, the first reported incidence and management of an ingested sewing needle migrating into the central nervous system of a cat.

An unusual intracranial metallic foreign bodies and panhypopituitarism

A 49 years old man, with a history of aggression at the age of 18 years by a pair of scissors, who consulted for unilateral migraine headaches look straight. Paraclinical explorations concluded that trauma to anterior pituitary by a metallic foreign body from the right nostril to the sella, responsible for panhypopituitarism and sinusitis. The headaches are frequent causes of consultation, often treated symptomatically but rarely explored. The direct trauma to the pituitary gland, by a metallic foreign body, is exceptional. We report the case of neglected panhypopituitarism, discovered 31 years after injury with a pair of scissors.