Knife Blade Penetrating Stab Wound to the Brain-Case Report-

Abstract

A 28-year-old man attempted to kill himself with a knife stab into the parietal area. Neuroimaging showed no vascular impairment except slow venous flow around the knife due to tamponading. After obtaining informed consent, the knife was removed through a craniotomy without new brain injury. Postoperative neurological findings showed no deficit. Follow-up angiography revealed no vascular impairment. No infection occurred. Brain stab wounds cause numerous complications, such as intracranial hemorrhage, injury of important vessels, and infections. Minimal blade movement during removal and precautions to prevent massive hemorrhage are essential.

Three years with a knife stuck in the brain

“…1,6 When the blade remains retained, it is necessary to remove it, and to do so, the approach must be carefully planned, due to the risk of recurrent bleeding in areas that were tamponade and additional injuries due to mobilization of the blade. 1,7 When a long-term permanence in nervous tissue occurs, it is expected that the reaction to the presence of the foreign body causes adhesion, as occurred in the case presented; it makes removal more difficult, requiring meticulous dissection to separate the blade from the surrounding tissue. Plain radiograph allows to assess the dimensions and location of the foreign body; computed tomographic scan, besides providing additional information regarding the size and path of the blade, allows the diagnosis of hematoma or abscess.…”

“…It is also important to perform an arteriography to check for large vessels nearby and to discard the existence of aneurysms or traumatic arteriovenous fistulas. 1,7 As usual, the craniotomy was performed with the object at its center, being small so that the flap does not obstruct the line of sight of the surgeon; to facilitate access to the affected area, a strip of bone was extracted from the skull, broadening the exposed region of the cerebrum. Blade movement can occur during craniotomy, especially at the end of procedure; 8 fixation with metal plates minimized this risk.…”

Penetrating Eye Injury

“…Orbital complications include globe rupture, retinal detachment, extraocular muscle injury, or optic nerve avulsion. Cranial penetration causes direct damage to vital structures and can be complicated by vascular trauma, hematoma formation, or infection [4,5].…”

Penetrating knife injury to the frontal lobe – a case report

“…[1][2][3][4][5] These cases are best treated in specialist neurosurgical centres in conjunction with the maxillofacial surgeons.…”

“…It is also important that the patient's head is in a fixed position and the weapon retrieved with minimal movement. 4 As the frontal lobe is associated with higher executive functions, damage to frontal lobe can cause severe personality changes despite the motor and sensory function being normal as illustrated by the famous case of Mr Phineas Gage, a railroad worker in Vermont who sustained frontal lobe damage following a tamping rod accident in the mid 19th century. 5 Although the patient described in the above case was referred to the neuropsychologists for a formal assessment of cognitive function, he did not attend these appointments and it is not possible to determine whether the cognitive function was affected in this case.…”