A Case-Based Review of the Management of Penetrating Brain Trauma

Milton, Jason; Rugino, Alex J.; Narayan, Kailash; Karas, Chris; Awuor, Victor

doi:10.7759/cureus.1342

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…Ideally, surgery should be performed within 12 hours for penetrating brain injuries if there is no obvious mass effect or active bleeding indicating the need for emergency surgery. 22 , 36 – 38 In our case, emergency sternotomy was indicated owing to the suspected LV rupture, hemopericardium, and shock. Our patient did not have neurological symptoms or imaging evidence of ICH that may have progressed rapidly.…”

Section: Discussionmentioning

confidence: 81%

Survival after multiple nail gun injuries to the brain, lung, and heart: a case report and a review of the literature

et al. 2021

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Most nail gun injuries involve the extremities and result from work-related accidents. Injuries to the brain or thorax are relatively rare, and cases with injuries to both regions are even rarer and often lethal. Initial evaluation, resuscitation, and surgical planning can be challenging for emergency physicians and surgeons. We present the details of a man with multiple nail gun injuries to the brain, lung, and heart following a suicide attempt. The patient presented to the emergency department in shock. After immediate resuscitation, emergent sternotomy, and subsequent craniotomy, he was discharged without significant morbidity. According to the literature, this is the only reported case involving multiple nail gun injuries to the brain, lungs, and heart. The mortality rate of multiple nail gun injuries involving the head and chest is approximately 20%. Rapid evaluation, immediate resuscitation, and appropriate imaging and surgery are crucial for increasing survival and achieving a good prognosis. Emergency sternotomy for cardiac injury is the foremost priority, and the timing of craniotomy depends on the patient’s vital sign status and whether brain injury is evident. A preprint of this article is available online: DOI: 10.21203/rs.3.rs-35448/v1.

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Section: Discussionmentioning

confidence: 81%

Survival after multiple nail gun injuries to the brain, lung, and heart: a case report and a review of the literature

et al. 2021

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“…Early decompression with conservative debridement of the brain may be needed. 7 In this patients, the most appropriate management in the field is to leave the transorbital object in situ and transport the patient to the trauma center carefully. Intravenous fluids are given and efforts are taken to maintain high blood oxygen levels.…”

Section: Discussionmentioning

confidence: 99%

Penetrating Brain Injury in Children

Ula

Dharmajaya

2019

AANHS-J

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Background: Accidental penetrating brain injury through supraorbital route is an unusual occurrence in emergency practice of civilian cases. At time, it could be potentially life threatening. We report an interesting case of supraorbital penetrating brain injury with an iron stick in a 12-year-old female patient. The stick was removed successfully through supraorbital exploration, without any neurovascular complications. Case Report: A 12-year-old female presented to our emergency department with injury to his right eye. History revealed that she was practicing marching band in her school as the leader. As she thrown the iron stick, she lost balance and that iron stick entered into her right supraorbital. Her Glasgow Coma Scale (GCS) score, on admission, was 15. There was circumferential laceration on the right supraorbital, flat margins, visible iron stick penetration with diameter 3 cm but no active bleeding was found. Rest of the physical and neurological examination findings were within normal limits. He was resuscitated promptly according to the advanced trauma life support system. Discussion: Intravenous fluids are given and efforts are taken to maintain high blood oxygen levels.Management of patients with transorbital brain injuries and foreign bodies in situ should follow basic surgical principles, including removal of the object under direct vision in order to reduce further brain tissue damage by the foreign bodies catching on bone fragments. Following removal of the foreign body, thorough debridement with removal of all involved skull bone and foreign materials, hematoma evacuation followed by careful hemostasis along the trajectory, and meticulous dural closure to reduce the possibility of CSF fistula are mandatory. A transorbital or transcranial approach can be chosen depending on the location of the fragment. Conclusion: In conclusion, supraorbital penetrating brain injury caused by an iron stick is a rare but fatal event. High index of suspicion toward the presence of foreign bodies and emergent surgical intervention is to be considered in spite of consistent lack of evidence on CT scan. Retrieval should be performed on the operating table under direct vision only after preoperative imaging of neurovascular structures. Keyword: Penetrating brain injury, Iron Stick

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“…Ideally, surgical intervention should be performed within 12 hours for penetrating brain injuries (18,32,33), that is, if there was no obvious mass effect or active bleeding that indicated emergency surgery (34). In this case, there is no doubt that emergency sternotomy was indicated due to suspected LV rupture, hemopericardium, and shock.…”

Section: Timing Of Interventionmentioning

confidence: 99%

Survival of multiple nail gun injuries to the head, lung, and heart: A case report

Wang

Chen

Huang

et al. 2020

Preprint

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Background: Most nail gun injuries occur at the extremities due to working accidents. Injuries to the brain or thorax are relatively rare, and cases with both injuries are even rarer. Initial evaluation, resuscitation and surgical planning can be challenging. Case presentation: Here, we present a case with nail gun injuries to the brain, lung, and heart by suicide attempt. The patient presented to the emergency department under shock. After resuscitation and surgical intervention, he was discharged without significant morbidity. Conclusions: Multiple nail gun injuries, especially those to vital organs such as the brain, lung, and heart, can be challenging to emergency physicians and surgeons. Imaging tools, treatment strategies, and possible complications are discussed in this article to provide optimized outcomes in such situations.

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A Case-Based Review of the Management of Penetrating Brain Trauma

Cited by 6 publications

References 3 publications

Survival after multiple nail gun injuries to the brain, lung, and heart: a case report and a review of the literature

Survival after multiple nail gun injuries to the brain, lung, and heart: a case report and a review of the literature

Penetrating Brain Injury in Children

Survival of multiple nail gun injuries to the head, lung, and heart: A case report

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