A Near-Miss: Arrow Trauma to the Skull Without Penetration

We report the case of a 77-year-old woman who presented to the emergency department (ED) after being unexpectedly struck in the head by an arrow while walking through a densely populated urban area in Barcelona, Spain. This highly unusual presentation in a modern city context prompted immediate multidisciplinary evaluation in the ED. Initial radiographs showed a metallic arrow tip in close proximity to the skull's cortical surfaces. Non-contrast head computed tomography (CT) and 3D reconstruction confirmed a left parietal soft tissue injury without intracranial penetration. The patient underwent a successful removal of the arrow under local anesthesia, with no complications, and was discharged without neurological deficits. This case highlights the critical role of advanced imaging and multidisciplinary collaboration in the management of cranial arrow injuries, even in densely urbanized settings. Continued case reporting is essential to inform and support the development of evidence-based approaches for these rare but potentially life-threatening events.