Stab wounds to the head; Case series, review of literature, and proposed management algorithm

Abstract

Background and Objectives: Stabbing the head is a rare event. It may occur following an assault or self-inflicted injury. We intend to report our experience with four such cases and review narratively the relevant literature. A treatment algorithm will be delivered. Materials and Methods: We have reviewed four of our cases; three were stabbed to the orbit and one to the head. Results: Enucleation was performed in one case. Vision could be preserved in the other two and brain abscess developed in the other cases due to a retained piece of knife. We made a comparison between our cases and those limited reports in the literature to reach an algorithm. Conclusion: The temporal region and the orbit are the targets mostly attacked in the craniofacial stabs. Since knives have a sharp and thin edge, they may break when penetrating the skull. The damage to the brain tissue and the retained piece of knife may be missed easily by overlooking the small injury to the scalp. The suggested algorithm would be a contrast-enhanced computed tomography scan of the skull and brain and a kind of brain vascular study are necessary, considering the location of the knife in the skull and brain passing the area with crowded vasculature. The best treatment protocol is surgery accompanied by antibiotic therapy.

Glial cells react to closed head injury in a distinct and spatiotemporally orchestrated manner

“…These models have been praised for their easy standardization and reproducibility of results, which could correlate to TBI outcomes in patients. However, SWIs account for a minor portion of TBIs in patients 23 , and similar to the CCI and FPI models, the SWI model relies on a complex surgical procedure—a craniotomy—which alone can cause intracerebral bleeding, edema formation, inflammation, and worsening of neurological scores 24 . Furthermore, in the cases of CCI and FPI, the direct impact on the brain causes extensive tissue loss and limits the predictive validity of the models 7 , 9 .…”

Patterned injuries from screwdrivers

“…A screwdriver may be favored more in countries such as Greece where the possession of a concealed knife is illegal, but not a screwdriver [ 4 ]. Such non-projectile penetrating cerebral trauma is rare accounting for only about 0.4% of all head injuries [ 5 , 6 ] and has involved a variety of objects including crochet hooks, a toilet brush handle, an antler, scissors, knitting needles, crossbow bolts, glass, car antennas, crowbars, pitchforks, a chair leg, and umbrella ribs [ 4 , 7 – 10 ]. In attacks with screw drivers, the skull is usually penetrated in areas such as the orbital plates (as in the reported case) and the nasal or squamous temporal bones where the bone is thin [ 4 , 6 ].…”

Construction Industry–Associated Penetrating Craniocerebral Injuries

“…The infection rate for patients with construction siteassociated injuries was higher than that for patients with bullet injuries 6 but similar to that for patients with nonbullet injuries. 3 Based on the recommendations in the literature, the antibiotic use should be longer than 1 week, and the antibiotic spectrum should cover gram-positive and gramnegative bacteria in such patients 7 ; however, this recommendation is still controversial. 8 All patients in this study were cured after receiving anti-infection treatment with vancomycin combined with meropenem, and no postoperative brain abscess occurred.…”

“…Early decompressive craniotomy can reduce the influence of intracranial hypertension on outcome and promote recovery. Small-incision surgery has also been used for these types of patients in foreign studies 3,14 ; its advantages and disadvantages require further investigation.…”

“…2 Metal foreign bodies penetrating the scalp and skull can cause serious central nervous system damage. 3 An accurate count of the incidence of such injuries is difficult due to extremely low occurrence. In China, penetrating craniocerebral injuries due to metal foreign bodies occasionally occur because of ongoing large-scale infrastructure construction.…”