Penetrating head trauma with four nails: an extremely rare case

Abstract

Yedi yıl önce şizofreni tanısı almış, 34 yaşındaki erkek hastanın kendi kafasına 4 adet çivi çakmasıyla gelişen nadir bir penetran kafa travması olgusu sunuldu. Fiziksel incelemede kafasının sağ temporal ve paryetal bölgesinde saçlı deri içerisinde kraniyuma çakılı 4 adet çivi vardı. Beyin omurilik sıvısı fistülü yoktu. Hastanın nörolojik incelemesinde motor ve duyu defisiti yoktu. Glasgow koma skoru 15 idi. Direkt kafa grafisinde ve beyin bilgisayarlı tomografisinde (BT) çivilerin yaklaşık 10 cm uzunluğun-da olduğu ve değişik yönlere uzandığı görüldü. BT anjiyografisinde büyük vasküler yapılarda yaralanma yoktu. Genel anestezi altında sağ temporal bölgede olan 2 çivi direkt çekilerek, sağ paryetal bölgede olan 2 çivi ise mini kraniyotomiler ile çıkarıldı. Temporal bölge gibi kemiğin ince olduğu alanlarda çivi direkt çekilip çıkarılabilir. Ancak paryetal kemik gibi kemiğin kalın olduğu bölgelerde bu yöntemle çivilerin çıkarılması her zaman mümkün olmayabilir.Anahtar Sözcükler: Çivi; penetran kafa travması; şizofreni We present a rare case of self-inflicted penetrating head trauma by a 34-year-old male who hammered four nails into his own head; he had been diagnosed with schizophrenia seven years before. On the physical examination, four nails were observed in the hairy scalp that had been driven into the cranium in the right temporal and parietal areas of the head. No cerebrospinal fluid fistulas were present. On the neurological examination, no motor or sensory deficits were present. The Glasgow Coma Scale was 15. On direct skull X-ray and cranial computerized tomography (CT), the nails were seen to be approximately 10 cm long and extending in various directions. No injury was observed in the main vasculature on CT angiography. Under general anesthesia, two nails in the right temporal area were removed by extraction, and the other two nails in the right parietal area were removed through a mini craniotomy. In areas such as the temporal area where the bone is thin, nails can be removed by extraction. However, in areas like the parietal bone where the bone is thick, removal of the nails using this method may not always be possible.

Thirty-two nails injected into the head: An operative report and review of the literature

“…[ 1 ] The case was done under general anesthesia. [ 1 ] Two of the nails were removed directly after making a small incision on the scalp. [ 1 ] The other two nails were extracted with a mini craniotomy.…”

“…[ 1 ] Two of the nails were removed directly after making a small incision on the scalp. [ 1 ] The other two nails were extracted with a mini craniotomy. [ 1 ] Although there is no difference in the reported morbidity between craniotomy versus craniectomy, both should be monitored closely for development of infection.…”

“…[ 1 ] Although there is no difference in the reported morbidity between craniotomy versus craniectomy, both should be monitored closely for development of infection. [ 1 , 14 ]…”

“…Arıcı et al described a patient presenting with four nails that penetrated the cranium. [1] e case was done under general anesthesia. [1] Two of the nails were removed directly after making a small incision on the scalp.…”

“…[1] e other two nails were extracted with a mini craniotomy. [1] Although there is no difference in the reported morbidity between craniotomy versus craniectomy, both should be monitored closely for development of infection. [1,14] Occasionally, the nail may penetrate an air sinus.…”