PDF icon Download PDF
Open Access
CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1809559
Review Article

Severe Head and Brain Trauma Due to Machete Wounds

Luis Rafael Moscote-Salazar 
1   Department of Research, Colombian Clinical Research Group in Neurocritical Care, Bogota, Colombia
2   Department of Research, AV Healthcare Innovators, LLC, Madison, Wisconsin, United States
4   School of Medicine, University of Cartagena, Cartagena, Colombia
5   Department of Research, Aneuclose LLC, Eagan, Minnesota, United States
,
Md Moshiur Rahman 
6   Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
,
Bibha Osti 
7   Medical Office in Spinal Injury Rehabilitation Center, Kathmandu, Nepal
,
William Florez 
1   Department of Research, Colombian Clinical Research Group in Neurocritical Care, Bogota, Colombia
,
Tariq Janjua 
6   Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
› Author Affiliations
› Further Information
Also available ateRefMedOne
 
 PDF Download Permissions and Reprints

Abstract

Serious cranial and brain injuries from machete wounds are an uncommon yet serious type of penetrating cranial injury, which can be associated with significant morbidity and mortality. Injuries from machete wounds may present with intricate patterns of skull fractures, brain contusions, intracranial hemorrhage, and deficits related to trauma to the brain. The clinical condition appears to be the principal determinant of prognosis, with most individuals sustaining injury with machete wounds having a poor outcome despite the provision of aggressive care. This narrative review will evaluate the clinical variables, imaging findings, management, and outcomes in association with acute or severe cranial injury secondary to machete wounds. The review will also include a case report of a 47-year-old male motorcycle passenger who sustained severe cranial trauma with upper limb injuries due to a machete assault. While the male underwent surgery and was subsequently provided with comprehensive critical care management, the individual suffered severe brain complications of cerebral edema and ischemic injury leading to herniation of the brain, ultimately leading to death. The review aimed to illustrate sequential imaging, particularly computed tomography imaging, as early as possible to characterize the extent of the damage and facilitate management decisions. Although the findings demonstrate that surgery may improve survival in patients sustaining injury from machete wounds, the overall prognosis could be poor due to the degree of the injury. Multidisciplinary management, which consists of urgent neurosurgical intervention, concomitant intensive care, and ongoing monitoring, is required for improved outcomes.


 

Keywords

severe head and brain trauma - machete injuries - penetrating cranial injury - neurosurgical management - brain contusion - intracranial hemorrhage - CT imaging - malignant edema - cerebral ischemia - traumatic brain injury

Introduction

A machete or cutlass is a broad, heavy knife or short sword. This is usually used as a cutting tool and a weapon. The blade is long, usually 12 to 24 inches, and slightly curved. There are different names for this tool based on regions: Golok, Bolo, and Panga. Severe brain and head injuries due to machete assaults are a critical and somewhat rare form of penetrating head injury. It is an urgent neurosurgical emergency involving multilevel skull fractures, extensive brain injury, and neurological deficits.[1] The complexity of the injuries and the severity of the trauma often impact the final results, although the prognosis usually remains poor because of the extent of the injury.[2] Machete-related head injuries are more prevalent in regions with higher levels of violence, and the management of machete-related head injuries poses particular challenges to health care providers, both from the vantage of urgent care and long-term recovery.[3] Penetrating head trauma as a result of machete injuries often results in direct brain injury and association with skull fracture, hemorrhage, and intracranial complications.[4] The complexity of these injuries requires multidisciplinary care, including urgent neurosurgical intervention, imaging, and supportive management.[5] This brief review will identify the critical elements of machete-related craniofacial trauma, its clinical features, imaging findings, and management from case reports and literature.


 

Case Illustration

A 47-year-old male presented after being attacked with a machete, sustaining multiple injuries to the scalp, skull, and upper limbs. The patient was found to be in severe pain, with generalized diaphoresis, and exhibited signs of acute distress. Upon physical examination, a contaminated wound was noted, exposing a large portion of the right parietal lobe. The Glasgow Coma Scale score was recorded as 13/15, with complex upper limb injuries. The cranial computed tomography (CT) scan showed diffuse cerebral edema, depressed fractures with displacement of bone fragments of the right parietal bone, early brain herniation, right parieto-occipital hemorrhagic contusion, subarachnoid hemorrhage in the right frontal region, and interhemispheric subdural hematoma. Additionally, a pneumocephalus was identified.

An emergent neurosurgical intervention included debridement, dural grafting, and wound lavage ([Fig. 1]). Despite the administration of antibiotics, blood transfusions, and inotropic and ventilatory support due to acute anemia and signs of hypovolemic shock, the patient's condition deteriorated. A follow-up contrast-enhanced CT scan revealed signs of malignant brain edema with cerebritis and cerebral infarcts. Unfortunately, the patient eventually succumbed to cardiorespiratory arrest.

Zoom
Fig. 1 Postoperative computed tomography (CT) scan showing bilateral infractions due to acute cerebritis, severe edema, and herniation (A–D).

 

Discussion

Epidemiology and Mechanisms of Injury

Head injuries resulting from machete attacks are relatively rare but represent a significant cause of morbidity and mortality in certain regions like Central America and the Caribbean. Studies have shown that such injuries often occur in contexts of violence or assaults, particularly in rural or conflict-prone areas. These traumatic events typically involve blunt force trauma, with the machete blade usually creating deep lacerations and fractures in the skull, which can directly penetrate the brain tissue, leading to extensive injury.[6] [7] [8] Research has indicated that machete-inflicted injuries to the skull occur with differing frequencies, most notably in countries experiencing high rates of violence between persons. For example, Omoke and Madubueze reported that machete attacks occur commonly in rural Nigeria but not as much as other traumas; therefore, even though they report many machete-related skull injuries, they pose a significant burden on emergency services—especially as penetrating skull injuries. The violence invariably causes direct injuries and serial injuries such as hemorrhagic contusions, subdural hematomas, and brain herniations as in the above case example.


 

Imaging and Diagnosis

CT scans play a critical role in assessing the extent of injury in patients with significant head and brain injuries, and details about skull fractures, intracranial hemorrhage, and brain edema can be obtained from this type of imaging. The current case illustrates the importance of imaging in determining acute surgical interventions. Radiological findings, such as cerebral edema, pneumocephalus, and contusions or hemorrhages, can have a significant influence on the treatment protocol.[9] Also, imaging techniques that include contrast-enhanced CT can help discern complications that arise in brain injuries, such as malignant brain edema and infarctions, that can hinder the management decisions for the patients. Imaging, as discussed by Crandon et al[10] and Enicker and Madiba,[11] is essential for evaluation and follow-up monitoring of the neurological status, as imaging can provide information on complications that may worsen the neurological condition and prognosis.


 

Management and Surgical Intervention

Machete-associated head and brain trauma are often managed with emergency surgical solutions such as wound debridement, bone fragment removal, and dura mater repair. In this case, the patient had esquirlectomy, dural grafting, and wound lavage performed to decontaminate the overlying wound and properly manage significant trauma. In a paper by Martin et al,[12] it has been asserted that prompt surgical intervention in machete cranial injuries improves survival rates. Nonetheless, this case demonstrates that aggressive intervention may still yield a guarded prognosis due to the sustained injury, massive brain damage, and overwhelming infection/brain edema/ischemia.

Most of the victims can have associated injuries including airway compromise. The tracheal transaction is mentioned in the literature and the definitive airway in such cases can be extremely challenging and requires a temporary airway followed by a definitive airway.[13]


 

Prognosis and Outcome

When serious head or brain injuries occur from machete injuries, the prognosis is usually poor and has high morbidity and mortality. The risk of infection is high and leads to poor outcomes.[11] The prognosis of severe head and serious brain injuries will depend on the severity and the location of the injury, the time to initiation of medical treatment, and if other associated injuries exist.[14] Patients will have severe neurological deficits, and even if they survive, the quality of life will be diminished in penetrating injuries, especially with large volumes of destroyed brain substance, as in this case[15] According to Adoga and Ozoilo, the prognosis can be improved with early intervention and aggressive care.[16] Still, again, sometimes the prognosis may be poor even after reasonable early intervention and care, especially if herniation of the brain or severe ischemia is present.[17]


 

 

Conclusion

While head and brain injuries caused by machete cuts are infrequent, they present a distinct dilemma in evaluation and treatment. These injuries are not only traumatic and difficult to assess but are often complicated by a risk of intracranial complications requiring immediate and aggressive treatment. CT scans are vital for evaluating the extent of the injury and directing the need for surgery. The prognosis overall is poor, mainly if there is brain herniation, cerebral edema, and ischemia. Timely management with surgical interventions, antibiotics, and observing trends is critical in severe cases to maximize prognosis.


 

 

Conflict of Interest

None declared.


Address for correspondence

Luis Rafael Moscote-Salazar, MD
AV Healthcare Innovators, LLC, Madison, WI 53716
United States   

Publication History

Article published online:
13 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India


  Permissions and Reprints
Zoom
Fig. 1 Postoperative computed tomography (CT) scan showing bilateral infractions due to acute cerebritis, severe edema, and herniation (A–D).