Management of screwdriver-induced penetrating brain injury: a case report
Shi et al. BMC Surgery
Management of screwdriver-induced penetrating brain injury: a case report
Jia Shi 0
Yumin Mao 0
Jiachao Cao 0
Bo Dong 0
0 Department of Neurosurgery, The Third Affiliated Hospital of Soochow University , Changzhou City 213003 , China
Background: Penetrating brain injury (PBI) can be caused by several objects ranging from knives to chopsticks. However, an assault with long and electric screwdriver is a peculiar accident and is relatively rare. Because of its rarity, the treatments of such injury are complex and nonstandardized. Case presentation: We presented a case of a 54-year-old female who was stabbed with a screwdriver in her head and accompanied by loss of consciousness for 1 h. Computer tomography (CT) demonstrated that the screwdriver passed through the right zygomatic bone to posterior cranial fossa. Early foreign body removal and hematoma evacuation were performed and the patient had a good postoperative recovery. Conclusions: In this study, we discussed the clinical presentation and successful management of such a unique injury caused by a screwdriver. Our goal is to demonstrate certain general management principles which can improve patient outcomes.
Screwdriver; Penetrating brain injury; Right zygomatic bone; Cranitomy
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Background
Intracranial injuries caused by penetrating foreign bodies
are associated with high risks of morbidity and mortality
due to relevant infection, seizures, vascular injury and
cerebrospinal fluid leakage [1, 2]. Penetrating brain injury
(PBI) in civilian population can be caused by almost all
sharp and blunt objects, ranging from knives and scissors
to chopsticks and screwdrivers [1]. To date, PBI with a
screwdriver is a peculiar accident and is relatively rare [3].
Screwdriver-induced PBI is severe and neglected [4, 5].
First, due to their length and spiral force, the tip of rigid
screwdrivers may be enable to penetrate into the calvarium,
and once through the bone, the screwdrivers may pivot
around the entry point in the skull and then cause curved
intracranial injuries, which are far more serious than the
damage of skin surface. Second, if the screwdriver is
withdrawn, the small entry wound may be missed by clinical
examination, and the seriousness of intracranial injuries
may also be overlooked [6]. Therefore, it is relatively
complex to manage such injuries owing to their rarity and
characteristics.
In this study, we discussed the clinical presentation
and successful management of such an unique injury
caused by screwdriver. Our goal is to demonstrate
certain general management principles which can improve
patient outcomes. It is worth mentioning that this case
report strictly adhered to care guidelines.
Case presentation
History
A 54-year-old-female patient, without addictions or
comorbidities, was admitted in our emergency department
due to assault with a screwdriver in her head and loss of
consciousness for 1 h. Her colleagues explained that she
suffered the injury hit by shedding electric screwdriver
when working in a factory, and the screwdriver penetrated
the right zygomatic bone (Fig. 1a). The injury was
associated with an immediate coma and bleeding of the right
ear. The patient had no history of vomiting or seizures.
Owing to the disorder of vital signs, the patient underwent
tracheal intubation in emergency department.
Examination
Neurological examination revealed a Glasgow Coma Scale
(GCS) of 3/15. A screwdriver was seen partially
penetrating the right cheekbone through a lacerated horizontal
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Fig. 1 a. Clinical picture showing a strewdriver penetrating the right cheekbone. b. Computed tomogram (CT) of brain showing the metallic
foreign body with metal artefacts. c-d. CT of head-brain window showing a metallic foreign body passed through the right cheekbone to
posterior cranial fossa. e-f. CT scan showing left cerebellar hematoma and subarachnoid hemorrhage
wound of 10 mm × 10 mm. The injury was accompanied
by left pupillary dilatation (5 mm) with disappeared
responsive to light, right pupillary dilatation (3 mm) and
unresponsive to light, and bleeding of right ear. There was
no evidence of any other injury.
A noncontrast axial computed tomographic (CT) scan
showed a metallic foreign body passing through the right
cheekbone to posterior cranial fossa, and a linear
structure extending from right temporal bone, petrous bone,
(...truncated)