Penetrating head injury
Patient suffered a head penetrating injury by a tree branch while driving snowmobile in a forest 10 days ago. The branch was surgically removed, MRI was performed to evaluate possible reason of clinical deterioration.
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There is slit-like wound channel in the right cerebral hemisphere, goes from anterior aspect of middle cranial fossa, penetrating through sphenoid sinus inside, medially from supraclinoid segment of internal carotid artery, affecting pituitaty gland and suprasellar cistern. Further channel goes through right cerebral pedicle, thalamus and lateral ventricle, ending at the inner plate of parietal bone. Total channel length is 11 cm. Blood clots in lateral ventricles.
Right sided subdural hemorrhagic collection 9 mm thick, left sided displacement 7 mm.
Sphenoidal and maxillary hemosinus.
Mucosal edema of mastoid cells on both sides.
Sporting activity, especially using vehicles is responsible for a significant number of head injuries. However, this case is of particular interest because of the rarity of such damages. Direct penetrating wound of the brain by tree branch and non-fatal damage to the great vessels and the brain is uncommon.
Primary surgery with removal of the branch was successful and residual left-sided hemiparesis was observed, but in a few days patient's condition worsened, that is why MRI was performed.
Subacute subdural hematoma was found as a cause of patient's condition worsening.