Intracranial Infection after Missile Injuries to the Brain: Report of 30 Cases from the Lebanese Conflict

Abstract

This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988. The follow-up period ranged from 1 month to 7 years (mean, 2.5 years). Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis. Infection developed 4 days to 7 years after the initial debridement. The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%). Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared. There was a 76% correlation between the organisms cultured from the dehisced scalp wound and the brain. Twenty-three patients had intracranial retention of bone. Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis. At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure. The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present. Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis. None developed a recurrent infection. The authors conclude that a bone fragment measuring less than 1 cm that is retained after treatment of intracranial infection caused by a missile injury to the brain does not have to be removed when there is not wound dehiscence or leakage of cerebrospinal fluid.

Missile Injuries of Brain – an Experience in Northern Sector

“…In our series, we had no case of brain abscess, this is important when we compare with 9% (4/47) septic intracranial complications reported in the missile injuries of the head during 1971 Indo-Pak War [21]. Though our period of follow up is comparatively shorter than other series [8,10,11], since majority (90%) of brain abscesses develop within 6 weeks of injury [22], the chances of late abscess formation will be remote. The main factor, which may relate to such a result in our series, is that we had no CSF leakage from operative wounds and majority (40) of our cases were operated within 48 hours and may be, early institution of effective antibiotics against intra cranial infections at forward hospitals might have contributed to some extent towards this result.…”

Brain Abscess Following Transorbital Penetrating Injury Due to Bamboo Fragments. Case Report.

“…2) Retained bone fragments after head injury may also cause infectious complications. 14,16) Therefore, close clinical observation and radiological examination are very important, as in our case, since there were retained bone fragments in the temporal lobe and the possibility of retained bamboo fragments could not be excluded.…”

An Unusual Penetrating Craniocerebral Injury Due To Landmine Explosion: A Case Report

“…The mortality rate of patients with infection has been reported to exceed 50%. [17] If CSF leakage occurs, especially longer than 24 hours, patients should be operated and dural repair performed to avoid possible complications such as meningitis and ventriculitis. [15] Tetanus vaccination and antibiotic prophylaxis are also mandatory medications in the management of these patients.…”