“Mosaic Pattern” Foreign Bodies in Computed Tomography of the Head: A Specific Sign to Detect Tempered Glass-Related Head Injury

Abstract

A 40-year-old male patient presented to us with a history of road traffic accident, followed by loss of consciousness and vomiting. Noncontrast computed tomography (NCCT) scan revealed frontal bone defect along with multiple “mosaic pattern” homogenously hyperdense foreign bodies of nearly similar size in the right frontoparietal region within the extradural space. Debridement craniectomy was done, and multiple pieces of glass were retrieved. The extremely unique radiologic finding and probably first in the English literature prompted us to report this interesting case. Unfortunately, the patient died of myocardial infarction 3 days after the injury. Further, this new “mosaic pattern” radiologic finding on NCCT of the head may help in determining the mechanism of injury due to tempered glass-related head trauma. Window glass may not be always safe as it is thought by commuters.

Keywords

mosaic - penetrating - tempered glass

• References

• 1 Carothers A. Orbitofacial wounds and cerebral artery injuries caused by umbrella tips. JAMA 1978; 239 (12) 1151-1152
• 2 Jooma R, Bradshaw JR, Coakham HB. Computed tomography in penetrating cranial injury by a wooden foreign body. Surg Neurol 1984; 21 (03) 236-238
• 3 Sharma A, Pandey A, Diyora B, Shah S, Sayal P, Dwivedi N. Intracranial penetration of a glass piece through the temporal region in civilian head injury. J Trauma 2006; 60 (04) 891-893
• 4 Nakagawa A, Su CC, Yamashita Y, Endo T, Shirane R. [A temporal head injury involving intracranial penetration by glass] [Japanese]. No Shinkei Geka 2002; 30 (05) 529-533
• 5 Fathalla H, Ashry A, El-Fiki A. Managing military penetrating brain injuries in the war zone: lessons learned. Neurosurg Focus 2018; 45 (06) E6
• 6 Luo W, Liu H, Hao S, Zhang Y, Li J, Liu B. Penetrating brain injury caused by nail guns: two case reports and a review of the literature. Brain Inj 2012; 26 (13) (14) 1756-1762
• 7 Woodall MN, Alleyne Jr CH. Nail-gun head trauma: a comprehensive review of the literature. J Trauma Acute Care Surg 2012; 73 (04) 993-996
• 8 Srivastava C, Sunil SK, Ojha BK. Intracranial penetrating glass injury: a case report. Indian Journal of Neurotrauma 2012; 9: 64-66
• 9 Liau LM, Bergsneider M, Becker DP. Pathology and Pathophysiology of Head Injury. In: Youmans JR. ed Neurological Surgery. 4th ed. Vol 3 Philadelphia: PA: W.B. Saunders; 1996: 1549-1594
• 10 llen TJ, Cox AR, Barton S. et al. Breaking of flat glass-part 4. Size and distribution of fragments from vehicle windscreens. Forensic Sci Int 1998; 93: 209-218
• 11 du Trevou MD, van Dellen JR. Penetrating stab wounds to the brain: the timing of angiography in patients presenting with the weapon already removed. Neurosurgery 1992; 31 (05) 905-911 discussion 911–912
• 12 Kieck CF, de Villiers JC. Vascular lesions due to transcranial stab wounds. J Neurosurg 1984; 60 (01) 42-46
• 13 Cristofori I, Pal S, Zhong W, Gordon B, Krueger F, Grafman J. The lonely brain: evidence from studying patients with penetrating brain injury. Soc Neurosci 2018; (e-pub ahead of print)