REVIEW

Traumatic brain injury (TBI) caused by a piece of wood in the temporal region - a case report and literature review.

Traumatismo Cranioencefálico (TCE) causado por pedaço de madeira na região temporal – um relato de caso e revisão de literatura.

  • Wesley Lopes da Silva (1)
  • Moysés Isaac Cohen (2)
  • Henrique Oliveira Martins (3)
  • Wellingson Silva Paiva (4)
  • Robson Luis Oliveira de Amorim (5)(6)
  Views: 988
  Downloads: 44

Resumo

Introdução: Lesões cerebrais penetrantes causadas por não projetil de fogo são raras. Na maioria dos casos, o orifício de entrada ocorre na região orbital. Apresentamos o caso de uma lesão cerebral traumática causada por um fragmento de madeira penetrando o cérebro na região temporal esquerda. Relato de caso: menina de 11 anos de idade residente em área rural da floresta amazônica foi acidentalmente atingida por um objeto contundente enquanto caminhava por uma rua durante uma tempestade. Apresentou-se com ferimento perfurocortante na região pré-auricular esquerda ao nível da região temporal, que foi suturado no hospital local. Seus pais a levaram para a capital do Estado. Após 12 horas, chegou ao hospital terciário onde uma tomografia computadorizada de crânio evidenciou uma lesão com hipodensidade linear no lobo temporal esquerdo com atenuação semelhante ao ar. Realizamos uma pequena craniectomia temporal que revelou um pedaço de madeira. Conclusão: Lesões cerebrais não intencionais causadas por objetos de madeira são raras, mas sempre devem ser suspeitadas quando uma tomografia computadorizada de crânio mostra um “pneumoencéfalo linear”.

Palavras-chave

Traumatismo cranioencefálico; Madeira; Corpo estranho; Osso temporal; Lesão penetrante

Abstract

Background: Non-missile penetrating brain injuries are rare. In most cases, the entry hole occurs in the orbital region. We present the case of a traumatic brain injury caused by a piece of wood entering the temporal area. Case presentation: an 11-year-old female child from a rural place in the Amazon forest was accidentally hit by a blunt object while walking along a street during a storm. She presented with a sharp wound in the left preauricular region at the level of the temporal region, which was sutured at the local hospital. Her parents took her to the State capital. After 12 hours, she got to the tertiary hospital, where a brain CT scan revealed a linear hypodensity in the left temporal lobe with attenuation similar to air. A small temporal craniectomy that showed a piece of wood was carried out. Conclusion: Unintentional brain injuries caused by wooden objects are rare but should always be suspected when a head CT scan shows a “linear pneumocephalus.”

Keywords

Traumatic brain injury; Wood; Foreign body; Temporal bone; Penetrating injury

References

1. Magalhães A, Cruz de Souza L, Faleiro R, Teixeira A, Miranda A. Epidemiologia do traumatismo cranioencefálico no Brasil. Rev Bras Neurol. 2017;53:2.

2. Kent Werner J Jr. Management of penetrating brain injury. In: Schmidek HH, Roberts DW, editors. Schmidek and Sweet: operative neurosurgical techniques. 6th ed. Philadelphia: Saunders/Elsevier; 2012. chap. 142, 2.350 p. (2 vol.).

3. Miller CF, Brodkey JS, Colombi BJ. The danger of intracranial wood. Surg Neurol. 1977;7(2):95-103. PMid:835079.

4. Ildan F, Bağdatoğlu H, Boyar B, Doğanay M, Cetinalp E, Karadayi A. The nonsurgical management of a penetrating orbitocranial injury reaching the brain stem: case report. J Trauma. 1994;36(1):116-8. http://dx.doi.org/10.1097/00005373-199401000-00020. PMid:8295236.

5. Nishio Y, Hayashi N, Hamada H, Hirashima Y, Endo S. A case of delayed brain abscess due to a retained intracranial wooden foreign body: a case report and review of the last 20 years. Acta Neurochir (Wien). 2004;146(8):847-50.; published online June 7, 2004. http://dx.doi.org/10.1007/s00701-004-0283-7. PMid:15254807.

6. Ishikawa E, Meguro K, Yanaka K, et al. Intracerebellar penetrating injury and abscess due to a wooden foreign body: case report. Neurol Med Chir. 2000;40(9):458-62. http://dx.doi.org/10.2176/nmc.40.458. PMid:11021077.

7. Al Mulla A, Purva M, Behbehani A. Fireworks injury: temporal bone penetration and a wooden intra-cranial foreign body. J R Coll Surg Edinb. 2001;46(4):249-51. PMid:11523722.

8. Andereggen L, Beck J. Overlooked piece of wood served as a vector transmitting clostridium perfringens: a case report emphasizing the awareness of gas-forming organisms in posttraumatic pneumocephalus. J Craniofac Surg. 2021;32(5):e485-7. http://dx.doi.org/10.1097/SCS.0000000000007445. PMid:33464773.

9. Wen ZH, Luo SQ, Peng YP, Chen GX, Qi ST. Misdiagnosis of intracranial foreign body: report of one case. J First Mil Med Univ. 2002;22(1):31.

10. McKinlay J, Smith JE. Penetrating brain injury: a case of survival following blast fragmentation injuries to the head. J R Nav Med Serv. 2013;99(2):55-6. http://dx.doi.org/10.1136/jrnms-99-55. PMid:24079203.

11. Fujimoto S, Onuma T, Amagasa M, Okudaira Y. Three cases of an intracranial wooden foreign body. No Shinkei Geka. 1987;15(7):751-6. PMid:3670545.

12. Vlková E, Slapák I, Hrachovina V. Penetration of an orbital foreign body into the intracranial space. Cesk Oftalmol. 1989;45(5):372-4. PMid:2805114.

13. Kaiser MC, Rodesch G, Capesius P. CT in a case of intracranial penetration of a pencil. A case report. Neuroradiology. 1983;24(4):229-31. http://dx.doi.org/10.1007/BF00399777. PMid:6828239.

14. Yano H, Nishimura G, Sakamoto K, Tanaka N, Dazai S, Hirano A. An intracranial wooden foreign body without neurological findings: case report. J Trauma. 1995;38(5):830-2. http://dx.doi.org/10.1097/00005373-199505000-00032. PMid:7760423.

15. Specht CS, Varga JH, Jalali MM, Edelstein JP. Orbitocranial wooden foreign body diagnosed by magnetic resonance imaging. Dry wood can be isodense with air and orbital fat by computed tomography. Surv Ophthalmol. 1992;36(5):341-4. http://dx.doi.org/10.1016/0039-6257(92)90110-F. PMid:1566235.

16. Potapov AA, Eropkin SV, Kornienko VN, et al. Late diagnosis and removal of a large wooden foreign body in the cranio-orbital region. J Craniofac Surg. 1996;7(4):311-4. http://dx.doi.org/10.1097/00001665-199607000-00012. PMid:9133838.

17. Dunn IF, Kim DH, Rubin PA, Blinder R, Gates J, Golby AJ. Orbitocranial wooden foreign body: a pre-, intra-, and postoperative chronicle: case report. Neurosurgery. 2009;65(2):E383-4, discussion E384. http://dx.doi.org/10.1227/01.NEU.0000347474.69080.A1. PMid:19625895.

18. Paiva, Monaco, Soares, Amorim, Andrade, Teixeira. Surgical treatment of a transorbital penetrating brain injury. Clin Ophthalmol. 2010;4:1103-5. http://dx.doi.org/10.2147/OPTH.S9638. PMid:20957055.


1 MD, MR, Medical Resident in Neurosurgery, Getulio Vargas University Hospital, Federal University of Amazonas – UFAM, Manaus, AM, Brazil.

2 MD, Neurosurgeon, Preceptor of Medical Residency in Neurosurgery, Getulio Vargas University Hospital, Federal University of Amazonas – UFAM. Student in Master of Medicine, Federal University of Amazonas – UFAM, Post-Graduation Program in Surgery, Manaus, AM, Brazil.

3 MD, Neurosurgeon, Student in Master of Medicine in Neurosurgery, Federal University of Amazonas – UFAM, Manaus, AM, Brazil.

4 MD, PhD, Neurosurgeon, Professor of Neurology, University of São Paulo – USP, São Paulo, SP, Brazil.

5 MD, PhD, Neurosurgeon, Professor of Neurology and Neurosurgery, Federal University of Amazonas – UFAM, Manaus, AM, Brazil.

6 Professor of Post-graduation, Faculty of Medicine, University of São Paulo – USP, Neurology Department, Supervisor of Neurosurgery Residency Program, Getulio Vargas University Hospital, Federal University of Amazonas – UFAM, Manaus, AM, Brazil.

 

Received Sep 4, 2022
Accepted Oct 18, 2022

JBNC  Brazilian Journal of Neurosurgery

  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786

Contact

Social Media

   

ABNc  Academia Brasileira de Neurocirurgia

  •   Rua da Quitanda 159 – 10º andar - Centro - CEP 20091-005 - Rio de Janeiro - RJ
  •   +55 21 2233.0323
  •    abnc@abnc.org.br

Sponsor

  • Brain4Care
  • Hospital INC
  • Strattner