DOI QR코드

DOI QR Code

Right-to-Left Displacement of an Airgun Lead Bullet after Transorbital Entry into the Skull Complicated by Posttraumatic Epilepsy : A Case Report

  • Chao-bin Wang (Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base) ;
  • Hui Wang (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine) ;
  • Jun-shuang Zhao (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine) ;
  • Ze-jun Wu (Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base) ;
  • Hao-dong Liu (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine) ;
  • Chao-jia Wang (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine) ;
  • An-rong Li (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine) ;
  • Dawei Wang (Department of Ultrasonography, Taihe Hospital, Hubei University of Medicine) ;
  • Juntao Hu (Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine)
  • Received : 2022.11.03
  • Accepted : 2023.02.08
  • Published : 2023.09.01

Abstract

Penetrating head injury is a serious open cranial injury. In civilians, it is often caused by non-missile, low velocity flying objects that penetrate the skull through a weak cranial structure, forming intracranial foreign bodies. The intracranial foreign body can be displaced due to its special quality, shape, and location. In this paper, we report a rare case of right-to-left displacement of an airgun lead bullet after transorbital entry into the skull complicated by posttraumatic epilepsy, as a reminder to colleagues that intracranial metal foreign bodies maybe displaced intraoperatively. In addition, we have found that the presence of intracranial metallic foreign bodies may be a factor for the posttraumatic epilepsy, and their timely removal appears to be beneficial for epilepsy control.

Keywords

References

  1. Aarabi B, Taghipour M, Haghnegahdar A, Farokhi M, Mobley L : Prognostic factors in the occurrence of posttraumatic epilepsy after penetrating head injury suffered during military service. Neurosurg Focus 8 : e1, 2000
  2. Bilotta F, Rosa G, Delfini R, Pinto R, Fiorani B : Unrecognized periorbital penetrating nail in the brain: case report. Am J Emerg Med 25 : 198-199, 2007 https://doi.org/10.1016/j.ajem.2006.05.029
  3. Borkar SA, Garg K, Garg M, Sharma BS : Transorbital penetrating cerebral injury caused by a wooden stick: surgical nuances for removal of a foreign body lodged in cavernous sinus. Childs Nerv Syst 30 : 1441-1444, 2014 https://doi.org/10.1007/s00381-014-2364-0
  4. Buttram SD, Garcia-Filion P, Miller J, Youssfi M, Brown SD, Dalton HJ, et al. : Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp Pediatr 5 : 79-84, 2015 https://doi.org/10.1542/hpeds.2014-0094
  5. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. : Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80 : 6-15, 2017 https://doi.org/10.1227/NEU.0000000000001432
  6. Darwazeh R, Darwazeh M, Sun X : Spontaneous migration of retained intracranial missiles: experience with 16 cases. Neurosurg Rev 45 : 2417-2430, 2022 https://doi.org/10.1007/s10143-022-01763-x
  7. DiGiulio GA, Kulick RM, Garcia VF : Penetrating abdominal air gun injuries: pitfalls in recognition and management. Ann Emerg Med 26 : 224-228, 1995 https://doi.org/10.1016/S0196-0644(95)70155-9
  8. Galtrey CM, Mula M, Cock HR : Stress and epilepsy: fact or fiction, and what can we do about it? Pract Neurol 16 : 270-278, 2016 https://doi.org/10.1136/practneurol-2015-001337
  9. Karadas S, Dursun R, Kiymaz N : Treatment of intracranial foreign body. J Pak Med Assoc 64 : 828-829, 2014
  10. Karlander M, Ljungqvist J, Zelano J : Post-traumatic epilepsy in adults: a nationwide register-based study. J Neurol Neurosurg Psychiatry 92 : 617-621, 2021 https://doi.org/10.1136/jnnp-2020-325382
  11. Kazanci A, Ozdemir HI, Kazanci B, Kazanci DO, Er U : Intracranial sewing needles in an adult patient. Turk Neurosurg 22 : 775-776, 2012 https://doi.org/10.5137/1019-5149.JTN.3854-10.1
  12. Lei P, Ong CD, Wang Y, Zhou J, Zhi ZY : Characteristics and management of gunshot wounds and nonpowder gunshot wounds to the head in civilian practice. J Trauma Surg 12 : 484-486, 2010
  13. Lei P, Zhang Y, Wu G, Zhi ZY : Removal of retained intracranial projectile shrapnel in 24 cases. Chin J Traumatol 16 : 576, 2000
  14. Lolli V, Pezzullo M, Delpierre I, Sadeghi N : MDCT imaging of traumatic brain injury. Br J Radiol 89 : 20150849, 2016
  15. Morton MJ, Korley FK : Head computed tomography use in the emergency department for mild traumatic brain injury: integrating evidence into practice for the resident physician. Ann Emerg Med 60 : 361-367, 2012 https://doi.org/10.1016/j.annemergmed.2011.12.026
  16. Muehlschlegel S, Ayturk D, Ahlawat A, Izzy S, Scalea TM, Stein DM, et al. : Predicting survival after acute civilian penetrating brain injuries: the SPIN score. Neurology 87 : 2244-2253, 2016 https://doi.org/10.1212/WNL.0000000000003355
  17. Rahimizadeh A : Intracranial migration of a broken rod after orbitocranial injury in an adult. World Neurosurg 121 : 232-238, 2019 https://doi.org/10.1016/j.wneu.2018.09.185
  18. Sharma S, Tiarks G, Haight J, Bassuk AG : Neuropathophysiological mechanisms and treatment strategies for post-traumatic epilepsy. Front Mol Neurosci 14 : 612073, 2021
  19. Thelin EP, Nelson DW, Vehvilainen J, Nystrom H, Kivisaari R, Siironen J, et al. : Evaluation of novel computerized tomography scoring systems in human traumatic brain injury: an observational, multicenter study. PLoS Med 14 : e1002368, 2017
  20. Towner JE, Pieters TA, Maurer PK : Lead toxicity from intradiscal retained bullet fragment: management considerations and recommendations. World Neurosurg 141 : 377-382, 2020 https://doi.org/10.1016/j.wneu.2020.05.112
  21. Tsranchev I, Timonov P, Alexandrov A : Penetrating brain trauma due to air gun shot - a case report. Folia Med (Plovdiv) 63 : 977-980, 2021 https://doi.org/10.3897/folmed.63.e59428
  22. Vakil MT, Singh AK : A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol 24 : 301-309, 2017 https://doi.org/10.1007/s10140-016-1477-z
  23. Wei LF, Wang SS, Jing JJ, Zheng ZC, Gao JX, Liu Z, et al. : Surgical therapy for craniocerebral firearm injury. Turk Neurosurg 23 : 491-497, 2013
  24. Wightman G, Beard J, Allison R : An investigation into the behaviour of air rifle pellets in ballistic gel and their interaction with bone. Forensic Sci Int 200 : 41-49, 2010 https://doi.org/10.1016/j.forsciint.2010.03.025
  25. Yue JK, Chang D, Han KJ, Wang AS, Oh T, Sun PP : Management of migrating intracranial bullet fragments in a 13-year-old female after firearm brain injury: technical and surgical nuances. Brain Inj 36 : 432-439, 2022 https://doi.org/10.1080/02699052.2022.2034185