RESUMEN
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-oldman 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 withmild 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.
Asunto(s)
Humanos , Masculino , Adulto , Lóbulo Parietal/cirugía , Lóbulo Parietal/lesiones , Heridas Punzantes/cirugía , Lesiones Traumáticas del Encéfalo/cirugía , Hemorragia Subaracnoidea/complicaciones , Puntaje de Gravedad del Traumatismo , Resultado del Tratamiento , Lesiones Traumáticas del Encéfalo/diagnóstico por imagenRESUMEN
A case of a patient operated on twice for a temporoparietal anaplastic oligondendroglioma, followed by radiotherapy, is reported. Although no intracranial recurrence has happened, a biopsyproven extracranial cervical lymphnode metastasis was diagnosed 15 months later. Surgical manipulation of the primary lesion by lymphatic and/or blood vessel invasion seem to be the main suspected factors in the development of CNS tumors metastasis in the head and neck region.