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NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 617

Fatal transorbital penetrating injury to brain by the clutch lever of a bike


Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Ashish Aggarwal
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.258053

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How to cite this article:
Aggarwal A, Batish A, Salunke P. Fatal transorbital penetrating injury to brain by the clutch lever of a bike. Neurol India 2019;67:617

How to cite this URL:
Aggarwal A, Batish A, Salunke P. Fatal transorbital penetrating injury to brain by the clutch lever of a bike. Neurol India [serial online] 2019 [cited 2019 Jul 16];67:617. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/617/258053




An 18-year-old male patient presented with a history of road traffic accident while he was riding a motorcycle. The exact details of the mode of accident were not known. The patient presented to our center approximately 5 h after the trauma having been referred from another center. On examination, the patient's pulse was 90/min, BP was 100/70 mm Hg, and Glasgow Coma Scale (GCS) was E1VTM3. A foreign body (FB) was protruding through the right orbit [Figure 1]a. This FB was the clutch lever of a motorcycle. An urgent non-contrast computed tomographic (NCCT) scan of the head [Figure 1]b and [Figure 1]c showed that the FB had entered the intracranial cavity through the right orbit and was lodged near the right anterior clinoid process. There was evidence of vascular injury in the form of an intraventricular haemorrhage (IVH), local contusion, and right sided hemi-infarct [Figure 1]d.
Figure 1: (a) The patient's photograph showing the foreign body protruding through the right orbit. (b) NCCT head bone window showing the FB in relation to the orbit and cranial cavity. (c) Three dimensional reconstruction of the skull showing the lodgement of the foreign body. (d) NCCT head showing the FB. The IVH and the infarct in the right hemisphere are also seen

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The patient was taken up for an urgent craniotomy. The Intraoperatively FB was dislodged carefully from the surrounding cranial structures. There was internal carotid artery (ICA) injury. After dislodgement of FB, there was bleeding, patient became hemodynamically unstable and was resuscitated. The patient was shifted to the intensive care unit for ventilation. However, he succumbed to his injuries, i.e., a massive brain injury secondary to right ICA injury. The case reiterates the fact that a penetrating injury may injure a major artery of the brain.[1],[2] It also emphasizes the importance of wearing a safety helmet with a shatterproof visor while riding a two- wheeler.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Huang J, Li D, Chen H. Successful management of a penetrating iron-rod injury through the oral cavity involving the posterior cranial fossa. Neurol India 2017;65:666-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Aggarwal A, Gupta D, Dhandapani S S. “Stroke by a pencil”: A friend turned fiend. Neurol India 2017;65:206-7.  Back to cited text no. 2
[PUBMED]  [Full text]  


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