Exotic injuries of the central nervous system

ABSTRACT

Head injuries are the most common reason for admission among the injured at the University Hospital of the West Indies. Intentional injuries account for 52 percent of all trauma admissions. We report a unique group of 6 patients with central nervous system injuries, all intentional with the offending weapon in situ on arrival at hospital. 4 patients had weapons embedded in the head two were knives, and one each was an ice-pick and a harpoon from a fishing device. The two other patients sustained spinal, cord injuries from ice-pick wounds. Principles of management involved radiological assessment of the injury to elucidate the position of the weapon, removal of the weapon under controlled circumstances in the operating theatre suite, prevention of infection and seizure prophylaxis. Operations performed were craniotomy, craniectomy and exploration of the spinal injuries. Two deaths occurred. In one, a spinal abscess developed six months after injury with the patient succumbing to sepsis. The other was an unexplained death following craniotomy and removal of a knive which severed the internal carotid artery. The cost of managing these intentional injuries was far greater than for the average patient and significantly demonstrates the burden on the taxpayer to treat these injuries(AU)