Traumatic posterior cerebral artery aneurysm secondary to an intracranial nail: Case report

Rezai, Ali R.; Lee, Mark; Kite, Charles; Smyth, Dennis; Jafar, Jafar J.

doi:10.1016/0090-3019(94)90399-9

Cited by 44 publications

(35 citation statements)

References 16 publications

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“…[9] Pseudoaneurysms due to trauma can be demonstrated in the early preoperative period and between the fourth and seventh postoperative days. [2,3,11] No vascular injury was detected on the preoperative cerebral CT angiography in our patient. Intracranial abscess, [12] meningitis [1][2][3]5] and seizures [13] are among complications that have been reported in the literature to occur following penetrating head traumas.…”

Section: Discussionmentioning

confidence: 87%

“…[6] This condition has been observed frequently especially in schizophrenia and major depressive disorder. [1][2][3][4][5] Intracerebral hematoma is one of the most important causes of mortality in strongly penetrant head traumas such as those caused by nails. These are usually rare and constitute less than 1% of wide intracranial aneurysm series and can be multiple.…”

Section: Discussionmentioning

confidence: 99%

“…The major causes of death are injuries of the main vasculature and infections. [1][2][3][4][5] Penetrating head traumas caused by nails are usually inflicted upon others. [6] Our case is interesting since the penetrating head trauma with nails was selfinflicted.…”

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confidence: 99%

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Penetrating head trauma with four nails: an extremely rare case

Arici¹,

Akgün²,

Kaplan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Yedi yıl önce şizofreni tanısı almış, 34 yaşındaki erkek hastanın kendi kafasına 4 adet çivi çakmasıyla gelişen nadir bir penetran kafa travması olgusu sunuldu. Fiziksel incelemede kafasının sağ temporal ve paryetal bölgesinde saçlı deri içerisinde kraniyuma çakılı 4 adet çivi vardı. Beyin omurilik sıvısı fistülü yoktu. Hastanın nörolojik incelemesinde motor ve duyu defisiti yoktu. Glasgow koma skoru 15 idi. Direkt kafa grafisinde ve beyin bilgisayarlı tomografisinde (BT) çivilerin yaklaşık 10 cm uzunluğun-da olduğu ve değişik yönlere uzandığı görüldü. BT anjiyografisinde büyük vasküler yapılarda yaralanma yoktu. Genel anestezi altında sağ temporal bölgede olan 2 çivi direkt çekilerek, sağ paryetal bölgede olan 2 çivi ise mini kraniyotomiler ile çıkarıldı. Temporal bölge gibi kemiğin ince olduğu alanlarda çivi direkt çekilip çıkarılabilir. Ancak paryetal kemik gibi kemiğin kalın olduğu bölgelerde bu yöntemle çivilerin çıkarılması her zaman mümkün olmayabilir.Anahtar Sözcükler: Çivi; penetran kafa travması; şizofreni We present a rare case of self-inflicted penetrating head trauma by a 34-year-old male who hammered four nails into his own head; he had been diagnosed with schizophrenia seven years before. On the physical examination, four nails were observed in the hairy scalp that had been driven into the cranium in the right temporal and parietal areas of the head. No cerebrospinal fluid fistulas were present. On the neurological examination, no motor or sensory deficits were present. The Glasgow Coma Scale was 15. On direct skull X-ray and cranial computerized tomography (CT), the nails were seen to be approximately 10 cm long and extending in various directions. No injury was observed in the main vasculature on CT angiography. Under general anesthesia, two nails in the right temporal area were removed by extraction, and the other two nails in the right parietal area were removed through a mini craniotomy. In areas such as the temporal area where the bone is thin, nails can be removed by extraction. However, in areas like the parietal bone where the bone is thick, removal of the nails using this method may not always be possible.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Penetrating head trauma with four nails: an extremely rare case

Arici¹,

Akgün²,

Kaplan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

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“…2,4,5,7,9,13,15) Pseudoaneurysms that rupture after head injuries are associated with particularly high rates of mortality of 32-54%. 5,9) In the present case, we performed endovascular trapping of the ICA to remove the nail safely and also to prevent fatal bleeding and other complications such as pseudoaneurysm formation and traumatic carotidcavernous fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular techniques may be useful to treat the injured ICA. 1,10,15) We treated a patient presenting with delayed cerebral ischemia caused by unstable stenosis of the ICA in the acute phase after a craniofacial nail-gun injury, using endovascular trapping to avoid further cerebrovascular deterioration.…”

Section: Introductionmentioning

confidence: 99%

Unstable Stenosis of the Internal Carotid Artery Caused by a Craniofacial Nail-Gun Injury -Case Report-

Hiraishi

Kawaguchi

Kobayashi

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 30-year-old carpenter suffered accidental piercing of his jaw by a 3-inch nail from a nail gun. No neurological deficits were found on admission. Computed tomography showed that the tip of the nail had reached the foramen lacerum. Cerebral angiography revealed severe stenosis at the C 4 portion of the left internal carotid artery (ICA) and marked decrease in the flow of the distal ICA. He had developed right hemiparesis and sensory aphasia by the following morning. T 2 -weighted and fluid-attenuated inversion recovery magnetic resonance imaging showed a focal hyperintense signal in the left central region indicating cerebral infarction. Repeat angiography demonstrated that the antegrade blood flow from the occluded point on the admission day had partially resumed, and endovascular trapping of the ICA was successfully carried out. The nail was then removed safely without problematic bleeding. The patient suffered no additional deficit, and his sensory aphasia and right hemiparesis gradually improved. The fluctuating blood flow through the unstable stenosis of the ICA related to nail movement possibly caused the delayed cerebral infarction. To avoid the occurrence of such events, rapid treatment after necessary investigations is recommended in patients with craniofacial penetrating injuries that affect the ICA.

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