Surviving the Scene in Civilian Penetrating Brain Injury: Injury Type, Cause and Outcome in a Consecutive Patient Series in Austria

Abstract

BackgroundPenetrating brain injury (PBI) is a heterogeneous condition with many variables. Few data exist on civilian PBI. In some publications, PBI differentiation between low-velocity injury (LVI) and high-velocity injury (HVI) is made, but exact definitions are not given yet. The incidence of PBI depends heavily on the country of origin. Furthermore, captive bolt pistol (CBP) injuries represent a rare type of LVI and almost no reports exist in the human medical literature. Treatment of PBI has been controversially discussed due to high morbidity and mortality with results varying considerably between series. Prognostic factors are of utmost importance to identify patients who presumably benefit from treatment.MethodsA retrospective, single-center analysis of a consecutive patient series was performed from September 2005 to May 2018. We included all patients with PBI who reached our hospital alive and received any neurosurgical operative procedure.ResultsOf 24 patients, 38% died, 17% had an unfavourable outcome, and 46% had a favourable outcome. In total, 58% of patients with PBI were self-inflicted. Leading causes of injury were firearms, while captive bolt pistols were responsible for 21% of injuries. LVI represented 54%, and HVI represented 46%. The outcome in HVI was significantly worse than that in LVI. A favourable outcome was achieved in 69% of LVI and 18% of HVI. Low GCS and pathological pupillary status at admission correlated significantly with an unfavourable outcome and death.ConclusionsPBI is a heterogeneous injury with many variables and major geographical and etiological differences. Differentiation between LVI and HVI is crucial for decision-making and predicting outcomes. In patients presenting with object trajectories crossing the midline, no favourable outcome could be achieved. Nevertheless, in total, a favourable outcome was possible in almost half of the patients who succeeded in surgery.

Civilian penetrating traumatic brain injury: A 5-year single-center experience

“…[2] In Austria, Marhold et al analyzed 27 patients with PTBI and concluded that initial GCS, trajectory, type of injury (low-or high-velocity), and pupil status are predictors of functional outcomes. [19] We have shown that the majority of our patients suffered from a stab wound which is a low-velocity penetrating object. Globally reported, non-missile low-velocity PTBI is a very rare condition.…”

“…analyzed 27 patients with PTBI and concluded that initial GCS, trajectory, type of injury (low- or high-velocity), and pupil status are predictors of functional outcomes. [ 19 ]…”

Particular Surgical Technique for Transorbital—Penetrating Craniocerebral Injury Inflicted by a Screwdriver: Technical Case Report

“…Based on the penetration speed, PBI can be divided into 2 categories, namely high-velocity penetration and low-velocity penetration. 13) This case is included in the category of low-velocity penetration. Preoperative planning is important t o determine the location of the foreign body and the extension of injury to the surrounding area.…”

“… 11 16) Impaired brain function can occur because of direct injury to the penetrating brain area or as an indirect result of vasospasm or multi-trauma injury from other locations. 2 5 7 13) The disturbances that occur can vary, for example in this case, the trajectory of the screwdriver penetrates through the white matter tract in the dominant frontal and temporal hemisphere areas, which can cause neurobehavioral disorders such as frontal lobe syndrome, cognitive impairment, sensory aphasia, hearing loss, and even hemiparesis. In our case, the patient did not experience any symptoms other than damage to the right eye.…”

Captive Bolt Gun-Related Vascular Injury: A Single Center Experience

“…Captive bolt gun (CBG) head injuries represent a rare form of penetrating brain injuries with only a few documented cases in the literature [1][2][3][4][5][6][7]. This is a device that is commonly employed in the meat industry to stun animals before slaughter [1,2]. A bolt penetrates the scull, causing direct and indirect injures to the brain parenchyma through bone fragments [1,2].…”