Self-Influcted Intracranial Injury Caused by a Crossbow Arrow

Abstract

The availability of sophisticated hunting and sports weapons such as modern crossbows increases the incidence of uncommon types of accidental, suicidal, and homicidal head injuries. This report describes the case of a 47-year-old man with a nonfatal head injury due to a crossbow broadhead hunting arrow penetrating the left frontal lobe. The injury was accidentally self-inflicted by the intoxicated patient. A review of the literature has shown that self-inflicted head injuries caused by arrows are a very rare or, at least, a seldom reported entity. The mechanisms and pathophysiology of penetrating head injuries caused by different kinds of projectiles are discussed in order to clarify the management of these cases.

Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report

“…5 In these cases, the conse-quences of the PBI depend on multiple factors, including the size of the penetrating object, the energy and speed of entry, the intracranial path, changes in intracranial pressure, and associated injuries. 1,6 Since the tip of the arrow and its shaft have the same diameter, the injury is generally limited to the tissues directly crossed by the blade, and may be non-fatal. 1,5 In the case herein reported, the crossbow arrow penetrated the right parietal calvaria and crossed both parietal lobes, with a palpable subcutaneous tip in the left parietal region.…”

“…Secondly, most case reports describe anterograde removal of the penetrating arrow to avoid further damage from the razorsharp blades. 1 Considering that no exit wound was found, we performed a careful retrograde removal followed by immediate CT imaging scans to exclude procedure-related damages.…”

“…It is less common than blunt head trauma, accounting for only 10% of all head injuries, although its consequences are generally worse. 1,2 Most cases of PBI are caused by gunshot bullets. Knives, arrows, spears, rocks, screwdrivers, chopsticks and other sharp objects have also been reported.…”

“…Knives, arrows, spears, rocks, screwdrivers, chopsticks and other sharp objects have also been reported. 1 Crossbow injuries represent a unique type of PBI in which a low-velocity foreign body (arrow) results in an intracranial fragment larger than high-velocity gunshot bullets. 3 There are very few reports in the literature regarding this type of PBI, each one requiring singular assessment and management.…”

Survived Crossbow Injuries

“…Since crossbows are also freely obtainable in Germany, as well as in many other countries, and are easy to handle by naive users, there are constant injuries and fatal cases, which can be attributed to inexperience and carelessness in handling crossbows. [1][2][3][4] There are, however, also cases of suicide and homicide by crossbows described in the literature. [5][6][7][8][9][10][11][12][13] In the Hamburg University Institute of Legal Medicine, there are 9 cases of crossbow arrow wounds documented during the last 15 years, 6 of which had a fatal outcome.…”