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Table of Contents    
CASE REPORT
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1462-1464

An Unusual Case of Penetrating Injury Skull with Metallic RCC Rod in A Child – A Rare Case Scenario with Review of Literature


Department of Neurosurgery, Christian Medical College, Ludhiana, Punjab, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Ashish Acharya
Department of Neurosurgery, Christian Medical College, Brown Road, Ludhiana, Punjab Pin 141 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304107

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 » Abstract 

Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, and motor vehicle or occupational accidents (nails, screw-drivers). Penetrating head injuries in children constitute even a smaller part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. A 6-year-old female presented in casualty with an iron rod penetrating into the skull.


Keywords: Non ballistic cranial injury, pediatric neuro-trauma, penetrating head injury
Key Messages: Non ballistic penetrating head trauma is rare scenario even in the civilian patients. Obtaining good outcome is rare but it is possible provided that the patient is operated upon promptly assuming they present quickly to the emergency room.


How to cite this article:
Acharya A, Bind RK, Sofat A, John PS PS, Grewal SS. An Unusual Case of Penetrating Injury Skull with Metallic RCC Rod in A Child – A Rare Case Scenario with Review of Literature. Neurol India 2020;68:1462-4

How to cite this URL:
Acharya A, Bind RK, Sofat A, John PS PS, Grewal SS. An Unusual Case of Penetrating Injury Skull with Metallic RCC Rod in A Child – A Rare Case Scenario with Review of Literature. Neurol India [serial online] 2020 [cited 2021 Jan 24];68:1462-4. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1462/304107




Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in the casualty. Most of the penetrating head traumas in pediatric population are ballistic injuries. Apart from gunshot and pellet injuries there are a number of household articles can cause penetrating injuries.


 » Case History Top


We report a case of a 6-year-old female child who presented in the casualty with the history of fall of part of ceiling over her; an iron rod penetrated into her head [Figure 1]. There was history of loss of consciousness and convulsions. At the hospital, the patient's GCS was E4V5M6, was hemodynamically stale. Pupils were equal in size and reacting normally to light. The Glasgow coma score (GCS) was 15/15. There was no motor or sensory deficit. Brainstem reflexes were normal. No associated systemic injuries were found.
Figure 1: Patient on presentation to emergency room

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X ray of skull [Figure 2] was done followed by NCCT head was done. Imaging showed that the iron rod had penetrated across the bony skull. The tip of the rod was seen to be impacted in the right petrous part of temporal bone coming out of skull above external auditory meatus and entry was from left occipital bone [Figure 3] and [Figure 4]. Patient was taken urgently to OT and necrotic brain tissue, the hematoma and bone fragments were removed after removal of the rod under sedation and local anaesthesia [Figure 5] and [Figure 6]. The wound was closed after thorough debridement. The patient had an uneventful recovery. There was no motor or sensory loss and she also had coherent verbal output.
Figure 2: X ray of skull showing intracranial extent of foreign body

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Figure 3: 3D reconstruction of CT head

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Figure 4: NCCT head- bone window showing trajectory of metallic rod

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Figure 5: Patient being prepared for OT

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Figure 6: 6 inch metallic rod after removal

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The absence of major neurological deficits in the postop period were miraculous. CT scan of the head was done on the second day to look for intracranial hematoma or abscess formation [Figure 7]. Postop period was uneventful and she was discharged on the 10th postoperative day with advice to take anti epileptics for 6 months. Audiometric analysis of the patient revealed no deficits whatsoever. There has been no report of seizure till date. At present she is on antiepileptics only. Her growth and development is normal for her age.
Figure 7: Post op CT head

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 » Discussion Top


Head trauma is exceedingly common in children, but it rarely presents as a penetrating injury of the skull. Most of these injuries are due to a fall.[1] Penetrating head injuries caused by foreign bodies other than bullet and shrapnel are extremely unusual. The most common entity being household object, e.g., knife injury, although bizarre cranio-cerebral perforating injuries have been reported, for example those caused by nails, metal poles, ice picks, pencils, chopsticks, and power drills.[2],[3],[4]

Low-velocity injuries differ from gunshot and missile injuries in that they do not cause concentric zones of cavitations and necrosis. Instead, the damage is predominantly restricted to haemorrhagic infarction in the line of the wound track.[5],[6] Early diagnosis is based on clinical evaluation, X-ray skull, and CT scan. Non-missile injuries should undergo a preoperative angiogram to rule out any vascular injury.

Complications most commonly encountered due to penetrating head injuries are infection and seizures. The infection rate is higher in patients with retained bone fragments. [4],[6],[7] CSF fistula and neuro-endocrine dysfunction are rare complications which if occur require meticulous workup and treatment.

To conclude, non-ballistic penetrating head injuries in paediatric patients constitute only a small part of the total fraction of traumatic head injuries seen in the emergency room. It may cause serious injury that might lead to irreversible brain damage and death. A focal neurological deficit may be absent if the noneloquent area of the brain is involved. It is ideal to operate the patient as early as possible to minimise infection rates. Our patient had presented immediately to the emergency room and was operated upon promptly.

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.
Jha AK, Kumar J, Harsh V, Kumar A. Penetrating injury of the posterior cranial fossa by a stone. Neurol India 2016;64:1081-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Satyarthee GD, Borkar SA, Tripathi AK, Sharma BS. Transorbital penetrating cerebral injury with a ceramic stone: Report of an interesting case. Neurol India 2009;57:331-3.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Atabaki SM. Pediatric head injury. Pediatr Rev 2007;28:215-24.  Back to cited text no. 4
    
5.
Pascual JM, Navas M, Carrasco R. Penetrating ballistic- like frontal brain injury caused by a metallic rod. Acta Nurochirurgica 2009;151:689-91.  Back to cited text no. 5
    
6.
Domingo Z, Peter JC, de Villiers JC. Low-velocity penetrating craniocerebral injury in childhood. Pedia Neurosurg 1994;21:45-9.  Back to cited text no. 6
    
7.
Salar G, Costella GB, Mottaran R, Mattana M, Gazzola L, Munari M. Multiple craniocerebral injuries from penetrating nails. J Neurosurg 2004;100:963.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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