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Good clinical practice in dubious head trauma - the problem of retained intracranial foreign bodies

Bernhard R Fischer1, Yousef Yasin, Markus Holling

  • 1Department of Neurotraumatology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.

International Journal of General Medicine
|November 3, 2012
PubMed

Insights

A penetrating head injury without neurological deficits can be fatal due to secondary complications. This case highlights the critical need for thorough examination in traumatic brain injury patients.

Area of Science:

  • Neurotrauma
  • Forensic Medicine
  • Neurosurgery

Background:

  • Traumatic head and brain injuries are a major cause of death and disability in young individuals.
  • Penetrating traumatic brain injuries can sometimes present without immediate neurological deficits.
  • Patients without initial deficits face risks of secondary injuries like infection, edema, and hematomas.

Observation:

  • A 19-year-old male sustained a head injury from an assault, presenting with no neurological deficits and a minor occipital wound.
  • Cranial neuroimaging revealed a knife blade penetrating the skull and nearing the superior sagittal sinus.
  • Post-removal, MRI confirmed the superior sagittal sinus remained patent.

Findings:

  • Despite the absence of neurological deficits, the penetrating brain injury had a fatal clinical course.
  • The case underscores the potential for severe outcomes even when initial clinical presentation appears benign.
  • Superficial examination can mask life-threatening intracranial pathology.

Implications:

  • Highlights the critical importance of advanced imaging in suspected penetrating head trauma, regardless of initial neurological status.
  • Emphasizes the medicolegal ramifications of underestimating seemingly minor head injuries.
  • Stresses the need for vigilance regarding retained foreign bodies in cranial trauma to prevent secondary complications.
Abstract

Keywords:
guidelineshead traumaneuroimagingretained object

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