Intracranial sewing needle in a man with seizure: a case of child abuse?

Area of Science:

• Neurology
• Pediatric Trauma
• Forensic Medicine

Background:

• Intracranial foreign bodies are typically associated with penetrating trauma or surgery.
• Child abuse, particularly physical abuse in infancy, can result in severe and lasting neurological deficits.
• The presentation of intracranial foreign bodies secondary to non-penetrating trauma or abuse is uncommon.

Observation:

• A 32-year-old male presented with generalized tonic-clonic seizures.
• Neurological examination and subsequent imaging were performed.
• Computerized tomography (CT) scan identified a sewing needle within the temporal lobe.

Findings:

• The needle's position suggested introduction during infancy through the lambdoid suture before its closure.
• The foreign body was likely a result of an attempted homicide or accidental injury in infancy.
• The intracranial foreign body was the presumed cause of the patient's seizures.

Implications:

• This case highlights the potential for severe neurological consequences from abusive acts in infancy, even when not immediately apparent.
• Early detection and intervention are crucial for managing neurological deficits resulting from childhood abuse.
• The case underscores the importance of considering non-accidental injury in the differential diagnosis of intracranial foreign bodies presenting with neurological symptoms.