Good clinical practice in dubious head trauma – the problem of retained intracranial foreign bodies

Abstract

Bernhard R Fischer,1 Yousef Yasin,2 Markus Holling,2 Volker Hesselmann31Department of Neurotraumatology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany; 2Department of Neurosurgery, 3Institute for Clinical Radiology, University Hospital of Muenster, Muenster, GermanyObjective: In young people, traumatic head and brain injuries are the leading cause of morbidity and mortality. In some cases, no neurological deficits are present, even after penetrating trauma. These patients have a greater risk of suffering from secondary injuries due to secondary infections, brain edema, and hematomas. We present a case report which illustrates that brain injuries that do not induce neurological deficits can still result in a fatal clinical course and death, with medicolegal consequences.Clinical presentation: A 19-year-old patient was admitted to hospital suffering from a head injury due to an assault. He reported that he was attacked from behind. Medical examination showed no neurological deficits, and only a small occipital wound. Neuroimaging of the cranium revealed that a knife blade was penetrating the cranial bone and touching the superior sagittal sinus.Intervention: After removing the foreign body, magnetic resonance imaging showed that the superior sagittal sinus remained open.Conclusion: We want to stress that possible problems can arise due to the retention of objects in the cranium, while also highlighting the risk of superficial clinical examination.Keywords: head trauma, guidelines, retained object, neuroimaging