Cerebral abscesses in children after pencil-tip injuries

Cerebral abscesses developed in three children after intracranial penetration by pencils. In two the pencil tip penetrated the orbital roof and in the third, the temporal bone. Intracranial penetration was not suspected in any of the cases at the time of injury and neurological problems developed 3 days to 3 weeks afterwards. The potential dangers of these unusual injuries may not be appreciated because the skin wounds are innocuous and initially the children are well. Surgical exploration is mandatory when there is a possibility of cranial penetration. Should a cerebral abscess develop, management should be by repeated aspiration, intravenous antibiotics, and elective excision of the residual abscess and foreign-body fragments together with a formal dural repair.