Transcranial stab wounds morbidity and medicolegal awareness.
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Transcranial stab wounds morbidity and medicolegal awareness.
- 1. TRANSCRANIAL STAB WOUNDS: MORBIDITY AND MEDICOLEGAL AWARENESS.
- 2. NABIL HASSAN M.KHALIL Emeritus Professor in Neurosurgery Department Faculty of Medicine Suez Canal University ,Ismailia Honorary president of ESNS Chief of Egyptian accreditation council for assigning neurosurgery university staffs Egypt Tel.+20663234244, Mobile.+20103732045 Email: nabilkh@hotmail.com
- 3. INTRODUCTION
- 4. In the 20th century, stab wounds of the skull and brain have become extremely uncommon. Most of the series reported come from South Africa. These studies draw attention to the pathology, anatomical features, and treatment of transcranial stabs. Unlike craniocerebral missile injuries, low velocity penetrating stab wounds damage a focal area along the tract. Thus the mechanisms of neuronal and vascular damage differ from other types of head injuries. The present study highlights the importance of distinguishing these wounds as an entity.
- 5. Cases of the frontal region : nnoo ssiittee SSeexx//aaggee GGCCSS NNeeuurroolloo ggiicc ddeeffiicciitt VVaassccuull aarr ccoommpprr eessssiioonn SSiiggnniiffiiccaa nntt rraaddiioollooggii ccaall ddaattaa ssuurrggeerryy oouuttccoommee 11 RRTT MM//2200 1155 nnoonnee nnoonnee CCTT,, RRTT.. FF.. ttrraauummaattiicc ttrraacctt ddeebbrriidd mmeenntt RReeccoovveerreedd,, nnoo ddeeffiicciitt 22 LLTT MM//1199 1155 nnoonnee nnoonnee LLtt.. ttrraauummaattiicc ttrraacctt oonn CCTT ddeebbrriiddee mmeenntt rreeccoovveerreedd
- 6. Cases of the frontal region Case (2). Plain x-ray skull showing slot fracture in the left frontal region
- 7. Con. Case 2. Case 2. CT scan following a left frontal stab and weapon withdrawal demonstrates a skull fracture with an in-driven fragment and pneumocephalus. There is minimal hemorrhage along the tract.
- 8. Diagrammatic picture of the anatomy of the vital structures involved in the temporal stabs.
- 9. Cases of the temporal stabs : nnoo ssiittee SSeexx//aaggee GGCCSS NNeeuurroolloo ggiicc ddeeffiicciittss VVaassccuullaarr ccoommpprreess ssiioonn SSiiggnniiffiicc aanntt rraaddiioolloogg iicc ddaattaa ssuurrggeerryy oouuttccoommee 33 LLtt.. MM//2233 33 PPiinnppooiinntt ppuuppiillss,, eexxtteennssoorr ppllaannttaarr nnoonnee PPllaaiinn xx-- rraayy rreessoollvveedd tthhee rreettaaiinneedd mmeettaall bbaarr RReemmoovvaa ll ooff rreettaaiinneedd iinnssttrruummee nntt DDiieedd,, ppoosstt--mmoorrtteemm,, llaacceerraatteedd ddeeiieenncceepphhaalloonn 44 RRtt MM//4455 1100 LLtt..hheemmii ppaarreessiiss nnoonnee CCTT,, llaacceerraattee dd tteemmppoopprr aall &&RRtt VV.. hhggee nnoonnee RReeccoovveerreedd,, hheemmiippaarreettiicc 55 LLtt.. MM//2222 33 FFiixxeedd ppuuppiill &&lloosstt OO.. CC rreefflleexx nnoonnee ------ ---------- DDiieedd,, ppoossttmmoorrtteemm,, sseevveerraannccee ooff ppoonnss &&BB.. aarrtteerryy 66 LLtt.. MM//2222 1133 SSlliigghhtt ffaacciiaall ppaallssyy ---------- PPeenneettrraattii nn kknniiffee RReemmoovvaa ll && ddeebbrriiddee mmeenntt RReeccoovveerreedd,, nnoo ddeeffiicciiiitt
- 10. Cases of the temporal region : Case 3. This patient was attacked with a pointed metal bar that penetrated deeply in the brain till the diencephalon. The bar was removed emergently but the patient died 2 days after the accident.
- 11. Con. Cases of the temporal region : Case 4. This patient was stabbed by screw driver, immediate CT brain revealed LT. Temporal Intracerebral hematoma extending to LT. Lateral ventricle.
- 12. Con. Case 4: Case 4. Follow up CT one month later revealed complete absorption of the hemorrhage and remained encephalomalacia through out the tract injury.
- 13. Con. Cases of the temporal region : Case 5. CT brain showing deep tract lesion through left temporal stab with knife (withdrawn by the assailant). Patient was deeply comatosed and died 2 hours after admission.
- 14. Con. Cases of the temporal region : Case 6. This patient was stabbed in the temporal area with a knife, plain x- ray skull, lateral view, confirmed intracranial penetration of the knife.
- 15. Con. Case no.6 : Case 6. A-P view of skull x- ray of the same patient confirmed intracranial penetration of the knife.
- 16. Cases of the orbital region: nnoo ssiittee SSeexx//aaggee GGCCSS NN..ddeeffiicc iittss VV..ccoomm pprreessssiioo nn SSiiggnniiffiicc aanntt RR.. ddaattaa ssuurrggeerryy oouuttccoomm ee 77 RRtt.. MM//1122 1133 nnoonnee RRtt.. CCaarroottiidd ccaavveerrnnoo uuss ffiissttuullaa CCoonnffiirr mmeedd bbyy aannggiiooggrr aapphhyy MMuussccllee eemmbboollii zzaattiioonn PPrrooppttooss iiss iimmpprroovv eedd 88 LLtt.. MM//7799 1155 IImmppaaiirree dd eexxttrraa-- ooccuullaarr mmoovveemm eennttss.. LLtt.. CCaarroottiidd ccaavveerrnnoo uuss CCoonnffiirr mmeedd bbyy aannggiiooggrr aapphhyy DDeettaacchh aabbllee bbaalllloooonn ccaatthheetteerr RReeccoovvee rreedd,, nnoo ddeeffiicciittss
- 17. Cases of the orbital region: Case 7. This boy was stabbed in his Rt.. Orbit and carotico-cavernous fistula developed one month from the injury causing Rt.. Proptosis.
- 18. Con. Cases of the orbital region : Post -operative picture of the same previous patient of the Rt.. Orbital trauma
- 19. Con. Cases of the orbital region trauma. Case 8. CT brain of a patient suffering Lt.. Proptosis one month after left transorbital stab.
- 20. Con. Cases of orbital stab : Case 8.Pre operative angiogram of the same previous patient showing the carotico- cavernous fistula
- 21. Con. Case no.8, orbital stab. Case 8. Post-operative angiogram, showing disappearance of the left carotid and muscle embolization through the left cervical common carotid.
- 22. CONCLUSION
- 23. In this series of eight patients with transcranial stab wounds, the importance of classification of such wounds as a separate traumatic entity is stressed. The mechanisms of neuronal and vascular damage in these wounds are discussed and are found to be specific from other head injuries. Cerebral injury by stabbing is largely restricted to the wound tract. Frontal stabs (2 cases) are accompanied by the least morbidity and mortality, where temporal stabs (4 cases), are commonly fatal. In Trans-orbital stabs (2 cases), carotid-cavernous fistulae resulted. Early recognition, administration of anti-tetanus serum and anti-biotics, and debridement may minimize complications.
- 24. Early recognition of stab wounds of the brain is essential to ensure early treatment and optimal outcome. Nevertheless, recognition remains difficult if the weapon has been withdrawn and hence the medicolegal importance. MEDICOLEGAL IMPORTANCE
- 25. THANK YOU