Survival with good outcome after traversing brainstem injury: case report

A penetrating injury to the brainstem is usually a fatal injury. The number of cases in which the brainstem is traversed during the injury and the patient survives is exceedingly small.

We report a case of an automobile collision in which blunt injury to the face of a 22-year-old man resulted in a fragment of the clivus being impacted posteriorly traversing through the pons in a left-sided through-and-through manner. The striking radiographic images demonstrate a potentially devastating brainstem injury. Surprisingly, the patient was able to follow commands and move his left side on arrival at the hospital.

The patient required a temporary tracheostomy and underwent surgical repair of his facial fractures. His hospital course was complicated by meningitis, and he required a long stay on the rehabilitation service. The patient made a remarkable recovery and became able to converse and walk with assistance. He has been able to live independently.

The striking radiographic images of this rare case illustrate an unusual pathology with an even more unusual outcome.