PURPOSE: To analyze the diagnostic efficacy of computed tomography angiography compared to digital cerebral angiography for the diagnosis of traumatic aneurysms (TAs) associated with combat-related penetrating head injuries and propose the most suitable angiography protocol in this clinical context. METHODS: A retrospective analysis was conducted on patients admitted to the neurosurgical clinic for penetrating traumatic brain injuries between February, 2022 and July, 2024, for whom both cerebral multidetector computed tomography angiography (MCTA) and digital cerebral angiography (DCA) were available. The inclusion were patients (1) with penetrating head injuries, (2) with missile trajectory traverses through the Sylvian or great longitudinal fissure, (3) basal cisterns with/or major subarachnoid hemorrhage. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. DCA was considered as the gold standard of diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. Descriptive statistics and nonparametric statistics were used to analyze the study results and their differences, respectively. RESULTS: A total of 40 patients with 45 TAs were included in the study. Of these, 26 patients (65.0%) were found to have aneurysms on MCTA. The median diameter of the aneurysms diagnosed by MCTA was 4.9 (3.6, 4.8) mm (range of 2.5 - 10.4 mm). However, the mean diameter of TAs not detected by MCTA but diagnosed by DCA was (3.0 ± 1.3) mm (range of 1.3 - 4.9 mm). MCTA demonstrated sensitivity and specificity of 35.5% and 99.5%, respectively, with positive and negative predictive values of 92.3% and 90.7%. CONCLUSIONS A low sensitivity of MCTA for the diagnosis of TAs associated with combat-related penetrating head injuries was reported. When MCTA is inconclusive in the setting of radiologic predictors of cerebral artery injury, DSA may be required.
Humans ; Male ; Retrospective Studies ; Adult ; Multidetector Computed Tomography/methods* ; Intracranial Aneurysm/etiology* ; Computed Tomography Angiography/methods* ; Female ; Head Injuries, Penetrating/diagnostic imaging* ; Middle Aged ; Cerebral Angiography/methods* ; Predictive Value of Tests ; Sensitivity and Specificity ; Young Adult

OBJECTIVE: Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. METHODS: The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. RESULTS: The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. CONCLUSION: PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.
Atherosclerosis ; Balkan Peninsula ; Blood Vessels ; Brain Injuries ; Brain ; Bulgaria ; Cadaver ; Chronic Disease ; Delivery of Health Care ; Ethnic Groups ; Facial Bones ; Fatty Liver ; Forensic Sciences ; Greece ; Head Injuries, Penetrating ; Humans ; Mortality ; Parietal Bone ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Skull ; Skull Base ; Suicide ; Toxicology ; Wounds, Gunshot

Penetrating cerebral injuries caused by foreign bodies are rare in civilian neurosurgical trauma, although there are various reports of blast or gunshot injuries in warfare due to multiple foreign bodies like pellets and nails. In our case, a 30-year-old man presented to neurosurgery clinic with signs and symptoms of right-sided weakness after suicide bomb attack. The skull X-ray showed a single intracranial nail. Small craniotomy was done and the nail was removed with caution to avoid injury to surrounding normal brain tissue. At 6 months'follow-up his right-sided power improved to against gravity.
Adult ; Explosive Agents ; Head Injuries, Penetrating ; surgery ; Humans ; Male ; Skull ; injuries ; Suicide

We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient.
Adhesives ; Angiography, Digital Subtraction ; Carotid Arteries ; Cavernous Sinus ; Decompression ; Foreign Bodies ; Head Injuries, Penetrating ; Hemostasis ; Humans ; Skull Base ; Wounds, Penetrating

Pencils are common instruments for children to use and play with. This report describes an unusual penetrating orbitocranial injury in a 5-year-old girl who was struck in her facewith a pencil. She was holding it at a desk, and her friend pushed her back. The pencil penetrated the left lower eyelid and went deep into the right frontal lobe through the base of the skull. It was removed at the emergency room, after which brain CT was performed to detect the development of an intracranial hematoma. No complications occurred after conservative management with antibiotics and an antiepileptic drug. Pencils can be hazardous to children, and a penetrating head injury with a pencil may be managed without cranial surgery.
Anti-Bacterial Agents ; Brain ; Child ; Craniocerebral Trauma ; Emergencies ; Eyelids ; Friends ; Frontal Lobe ; Head Injuries, Penetrating ; Hematoma ; Humans ; Preschool Child ; Skull

A man attempted suicide by shooting seven nails into his head with a nail gun; five in the right temporal region and two in the left. He subsequently presented at the emergency department with complaints of headache. He was found to be oriented in space and time, with no focal neurological deficits. The patient handed the nail gun to the doctors and informed them that he had earlier attempted suicide. Radiological studies showed the presence of nails arranged like a 'martyr's crown'. The man died six days after the surgical removal of the nails. Autopsy was refused by Italian authorities. We conclude that imaging techniques are an adjuvant to forensic medical diagnosis and forensic autopsies.
Construction Materials ; Foreign Bodies ; diagnostic imaging ; Head ; diagnostic imaging ; Head Injuries, Penetrating ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Radiography ; Suicide

Traumatic brain injury (TBI) is a highly complex multi-factorial disorder. Animal models of TBI are used to elucidate primary and secondary injury mechanisms and pathophysiological changes and to provide the diagnostic and therapeutical basis for TBI. The choices of animal models depend upon the research objectives. However, various animal models have limitations. The models only can duplicate the pivotal injury mechanisms or a certain important pathophysiological course. The characteristics of human TBI can not fully be reflected by using these models. In the review, animal models of traumatic brain injury are classified as dynamic direct brain injury, indirect dynamic brain injury and combined neuro-traumatic models. Several common models are described for consideration.
Animals ; Biomechanical Phenomena ; Brain/physiopathology* ; Brain Injuries/physiopathology* ; Diffuse Axonal Injury/physiopathology* ; Disease Models, Animal ; Forensic Medicine ; Head Injuries, Closed/physiopathology* ; Head Injuries, Penetrating/physiopathology* ; Humans ; Mice ; Rats ; Reproducibility of Results

PURPOSE: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. METHODS: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea. RESULTS: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. CONCLUSION: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.
Abscess ; Brain ; Brain Abscess ; Child ; Early Diagnosis ; Fever ; Head Injuries, Penetrating ; Heart Diseases ; Humans ; Intracranial Pressure ; Korea ; Pneumonia ; Retrospective Studies ; Seizures ; Streptococcus

OBJECTIVE: Streptococcus pyogenes is a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as group A streptococci (GAS). There have been five reported case in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury. We present a patient who suffered from penetrating skull injury that resulted in a brain abscess caused by Streptococcus pyogenes. METHODS: The patient was a 12-year-old boy who fell down from his bicycle while cycling and ran into a tree. A wooden stick penetrated his skin below the right lower eyelid and advanced to the cranium. He lost consciousness on the fifth day of the incident and his body temperature was measured as 40degrees C. While being admitted to our hospital, a cranial computed tomography revealed a frontal cystic mass with a perilesional hypodense zone of edema. There was no capsule formation around the lesion after intravenous contrast injection. Paranasal CT showed a bone defect located between the ethmoidal sinus and lamina cribrosa. RESULTS: Bifrontal craniotomy was performed. The abscess located at the left frontal lobe was drained and the bone defect was repaired. CONCLUSION: Any penetrating lesion showing a connection between the lamina cribrosa and ethmoidal sinus may result in brain abscess caused by Streptococcus pyogenes. These patients should be treated urgently to repair the defect and drain the abscess with appropriate antibiotic therapy started due to the fulminant course of the brain abscess caused by this microorganism.
Abscess ; Body Temperature ; Brain ; Brain Abscess ; Child ; Consciousness ; Craniotomy ; Edema ; Eyelids ; Frontal Lobe ; Head Injuries, Penetrating ; Humans ; Skin ; Skull ; Streptococcus ; Streptococcus pyogenes

Adult ; Head Injuries, Penetrating ; diagnostic imaging ; etiology ; surgery ; Humans ; Male ; Orbit ; injuries ; Tomography, X-Ray Computed