Craniocerebral injuries from dog bites

Abstract

Dog bites are increasingly being recognized as posing a major public health problem. In the U.S., Weiss et al. reported a rate of 12.9 per 10,000 persons, for dog-bite related injuries resulting in a total of 333,687 visits to Emergency Departments 1 . Children most commonly fall victim, where the head and neck are the most frequent sites of injury accounting for some 80% of such cases.To date, craniocerebral injury cases caused by dog bites have been little published in the medical literature 2,3 . Two cases of penetrating head injury from dog bites are presented and discussed in the context of the current literature on clinical and radiological evaluation, and treatment. CaseThis study was approved by the commission of ethics of the institution and we obtained the informed consent of the responsible for the patients for publication. Case 1On January, 2006 a previously healthy two-year-old boy was brought to the "Hospital das Clínicas" of São Paulo 12 hours after being attacked by a Rotweiller dog in the head. The boy did not lose consciousness, remained alert and responded appropriately. Examination showed a scalp injury on both sides of the head. The CT scan disclosed a depressed skull fracture in the right temporal bone, where the scalp injury was larger (Fig 1A). The child was submitted to surgery with a large incision. There were five depressed skull fractures in the temporal and parietal bones, not directly under the scalp injury itself, which were repaired with a wide craniotomy. The next day the child presented CSF leakage on the left side from the scalp injury, and underwent surgery for a second time. The second CT scan showed a skull fracture in the left temporal bone, not revealed in the first CT scan (Fig 1B). Surgery was carried out on this side and two depressed skull fractures were found not under the scalp wound, but some distance away (Fig 1C, 1D). A large craniotomy was performed and the dural laceration was treated. The boy received a wide spectrum prophylactic antibiotic (oxacilin, ceftriaxone and metronidazol) for 14 days, anti-rabies and anti-tetanus vaccines, rabies immunoglobulin, where treatment was complemented with psychological therapy. At a twelve month-follow-up, the boy was normal without any handicap. Case 2On May, 2006 a previously healthy three-year-old girl was brought to the "Hospital das Clínicas" of São Paulo 10 hours after she had been attacked to the head by a pitbull dog. She did not lose consciousness and presented scalp injuries on both sides of the head as well as to the posterior region of the head. The girl was conscious and responded appropriately. The CT scan showed a complex depressed skull fracture in the left temporal bone; two depressed skull fractures in the occipital bone and signs of pneumocephalus. The 3D CT showed both bone and brain injuries (Fig 2). The girl was submitted to surgery with wide exposure of the lesions. Fractures and dural lacerations were corrected and (Figs 3 and 4). After surgical treatment she received prophylactic antibiotics (oxacili...

A Forensic and Medical Evaluation of Dog Bites in a Province ofWesternTurkey

“…Most of the cases (73.2%) had injuries such as bruising and abrasions, while the least percentage (1.8%) had vascular injury. This result is compatible with studies about the incidence of injuries due to dog bites . This result gives important clues in terms of the nature of dog bites and indicates that most dog bites result in simple injuries.…”

“…These results highlight the fact that children are more sensitive to dog bites. In addition, injury to the head–neck–face was more common in children than in adults (68.2% and 31.8%, respectively) ( p < 0.001), a finding compatible with many studies . As children are shorter and lighter than most adults, dogs can reach the head–neck regions directly.…”

Neurosurgical sequelae of domestic dog attacks in children

“…The strong jaw pressure of large-breed dogs along with the ability of the jaws to encompass both sides of a small child's skull leads to a high rate of depressed skull fractures. 1,5,17,23 Penetrating bone fragments may cause parenchymal or vascular injury. Less dramatic skull fractures commonly involved a puncture hole in the skull 11 with or without dural tear, likely caused by penetration by the dog's large canine teeth.…”

Intracranial Injury after a Dog Attack in a Neonate

“…Moreover, the thinness of the skull bones can lead to disastrous neurological consequences with the possible association of dural and brain injuries. These types of lesions, described in our child are not common, some cases have been reported in the literature, [6][7][8][9] but as far as we know, there is no report in a neonate.…”