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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(02): e179-e182
DOI: 10.1055/s-0040-1719008
Case Report | Relato de Caso

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

Lesão cerebral penetrante bi-hemisférica não fatal por flecha de besta com bom desfecho clínico: Relato de caso
José Gonçalo de Oliveira Machado Saraiva Januário 
1   Department of Neurosurgery, Hospital de São José, Lisboa, Portugal
,
Gonçalo Abreu Mesquita Borges de Almeida
2   Department of Neuroradiology, Hospital de São José, Lisboa, Portugal
,
Carlos José Rios Godinho Calado
1   Department of Neurosurgery, Hospital de São José, Lisboa, Portugal
,
Joaquim António Toscano Ferreira Monteiro
1   Department of Neurosurgery, Hospital de São José, Lisboa, Portugal
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Abstract

Crossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome. We present the case of a 34-year-old man who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later with mild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.

Resumo

As lesões cranianas causadas por bestas raramente foram relatadas na literatura, e representam um tipo único de lesão cerebral penetrante (LCP), na qual uma flecha de baixa velocidade resulta em um fragmento intracraniano maior do que a maioria dos projéteis de alta velocidade, geralmente com um resultado letal. Apresentamos o caso de um homem de 34 anos que tentou suicídio com lesão craniana autoinfligida por uma flecha de besta, com um ponto de entrada parietal direito e uma ponta subcutânea palpável na região parietal esquerda. A equipe de emergência relatou uma pontuação na escala de coma de Glasgow (ECG) de 15, e o paciente foi levado sedado e intubado. A tomografia computorizada (TC) mostrou que a seta cruzava ambos os lobos parietais, com ligeira hemorragia subaracnoideia e pequenas contusões cerebrais adjacentes ao seu trajeto intracraniano. Foi realizada remoção retrógrada cuidadosa da flecha penetrante na sala de TC, seguida de TC imediata, que excluiu complicações relacionadas ao procedimento. O paciente acordou facilmente e recebeu alta 3 dias depois com apraxia leve da mão esquerda e sem outros défices neurológicos. Do que sabemos, não há relatos de casos semelhantes que descrevam bom resultado clínico e alta rápida após LCP bihemisférica. Individualizar o tratamento de cada paciente é, portanto, crucial para alcançar o melhor resultado possível, pois os casos de LCP ainda representam um grande desafio para neurocirurgiões praticantes em todo o mundo.

Keywords

Craniocerebral Trauma - penetrating brain injury - foreign bodies - posttraumatic subarachnoid hemorrhage

Palavras-chave

trauma craniocerebral - lesão encefálica penetrante - corpos estranhos - hemorragia subaracnoideia pós-traumática


Publication History

Received: 11 May 2020

Accepted: 04 September 2020

Article published online:
15 February 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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