Intracranial stab wound: a case report

Intracranial stab wounds are relatively uncommon, as the adult skull usually provides an effective barrier to penetration. We present an interesting case of a penetrating intracranial stab wound with several important teaching points.

A 44-year-old man presented to the emergency department with a 1.2-cm stab wound to the left temporal area. His initial Glasgow Coma Score was 14/15. Computerized tomography of his brain revealed a left temporal lobe haemorrhage and contusion. Magnetic resonance images of his brain revealed a linear haematoma extending from his left temporal lobe into the left middle cerebellar peduncle, consistent with a penetrating injury. He was managed conservatively with intravenous antibiotics and made an excellent recovery. Three weeks after injury, he had mild residual problems with recall and attention.

Several leaning points exist in this case. Firstly, as stab wounds to the brain frequently present as apparently innocuous facial or scalp lacerations, a high index of suspicion is needed to prevent these injuries presenting with serious late infective complications. Secondly, reports of similar cases in the literature suggest that stab wounds to the temporal region are associated with a high morbidity and mortality. This case demonstrates that a patient with an injury such as this can occasionally make a good functional recovery. Finally, this case highlights the advantage of magnetic resonance imaging over computerized tomography in patients with these injuries once it has been established that there is no residual intracranial metal fragment prior to magnetic resonance imaging. In this case, the entire wound tract was only evident on magnetic resonance imaging and not on the initial computerized tomography scans.