Abstract:Cranial impalement injuries are rare. They occur from a variety of objects, and via different mechanisms. We describe the case of a 5-year old boy who suffered cranial impalement injury via a unique mechanism. He presented to our centre with an impacted 17.8cm long metallic rod (a fence spike) in the vertex of his cranium, just off the midline. The spike penetrated his head and broke off its supporting frame as the frame was falling off a collapsing brick fence. He was transported as soon as possible to the hospital by relatives, without any attempt to remove the impaled spike. An urgent cranial computerized tomogram was done, and the object was removed under general anaesthesia in the operating theatre. The patient had complete recovery and was subsequently discharged from the hospital, with no residual neurological deficit. This case demonstrates a rare mechanism of cranial impalement. It also highlights the importance of following basic principles in the management of such injuries.
Vein of Galen malformations and Fahr's syndrome are rare neurological disorders. Their neurological manifestations may parallel, as is some radiological presentations in certain scenario. They may be congenital but that may be as far as their similarities go as they are pathologically distinct entities with clearly defined natural courses. The unusual parallel of their characteristic neuroradiological findings in the setting of vein of Galen malformations could becloud diagnosis, due to unfamiliarity with the manifestations as a result of their rarity. Our patient presented post-partial thrombosis of vein of Galen malformation. Neuroimaging showed typical intracranial calcifications of the basal ganglia, subcortical white matter, thalami and cerebellum. The radiological report identified the vein of Galen malformation but also noted that Fahr's syndrome should be ruled out. The occurrence of intracranial calcifications in the setting of vein of Galen malformation is not a usual event, and normally, in the literatures, vein of Galen malformation is not listed as a cause of multiple intracranial calcifications. Therefore, in such a setting, diagnostic dilemma may occur. We described this patient and reviewed the current literature to clarify mechanism of intracranial calcification formation in vein of Galen malformation.
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