Trauma craneoencefálico penetrante por una herida de arpón. Presentación de un caso / Penetrating cranioencephalic trauma due to harpoon wound. Presentation of a case

RESUMEN Las heridas craneocerebrales penetrantes más frecuentes son las provocadas por armas de fuego; las restantes resultan de rara frecuencia. Se presentó un caso que recibió agresión craneoencefálica por arpón, de forma accidental, fuera del agua. Se describieron los detalles del suceso, los exámenes complementarios, la conducta adoptada, el manejo neuroquirúrgico, y la sorprendente evolución postoperatoria del paciente (AU).

ABSTRACT The most frequent penetrating craniocerebral wounds are those caused by firearms; the remaining ones are rare. We presented a case that received accidental cranioencephalic aggression by harpoon, an event that occurred out of the water. Details of the event, complementary examinations, adopted behavior and neurosurgical management that were decided, as well as the surprising post-operative evolution of the patient were described (AU).

Head home: implementation during COVID-19 pandemic.

BACKGROUND: Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS: Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED. RESULTS: Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018. CONCLUSION: We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.

Treatment of a self-inflicted intracranial nail gun injury.

A 30-year-old man walked into the emergency department after a suicide attempt by firing a nail from a pneumatic nail gun directed at his left temple. He was haemodynamically stable and neurologically intact, able to recall all events and moving all extremities with a Glascow Coma Scale of 15. CT of the brain showed a 6.3 cm nail in the right frontal region without major intracerebral vessel disruption. He was taken to the operating room for left temporal wound washout, debridement of gross contamination and closure with titanium cranial fixation plate. The foreign body was not accessible on initial surgical intervention and was left in place to define anatomy and plan for subsequent removal. Thin slice CT images were used to create 3D reconstructions to facilitate stereotactic navigation and foreign body removal via right craniotomy the following day. The patient tolerated the procedures well and recovered with full neurological function.

Migración de proyectil en vía aérea. Reporte de un caso / Bullet migration in the airway. Case report

A propósito de un caso de migración de un proyectil de arma de fuego en la vía aérea, en el contexto de una agresión con múltiples lesiones por proyectil de arma de fuego, se analiza la ubicación final del proyectil en el bronquio lobar inferior derecho tras ingresar en la región escapular izquierda, y las posibles causas de su trayecto por la vía aérea. Se remarca el concepto de «proyectil errante», el conocimiento de tal fenómeno y su importancia en la búsqueda y hallazgo de los mismos

Concerning the case of the migration of a firearm projectile in the airway, in the context of an attack that produced multiple projectile impacts on the body; this analysis includes the study of the final location of the projectile in the lower right lobar bronchus, after entering the left scapular region, and of the possible causes of its wandering course through the airway. This essay focuses on the concept of 'wandering bullets', the knowledge surrounding the phenomenon and the importance of searching and finding them during autopsy

Left rostrolateral prefrontal cortex lesions reduce suicidal ideation in penetrating traumatic brain injury.

OBJECTIVES: The objective of this study is to evaluate the relationship between suicidal ideation (SI), structural brain damage, and cognitive deficits in patients with penetrating traumatic brain injury (pTBI). METHODS: Vietnam War veterans (n = 142) with pTBI to the prefrontal cortex (PFC) underwent combination of neuropsychological and psychiatric examinations and non-contrast CT brain scan. Patients were divided into SI positive (SI+) and SI negative (SI-) groups according to the SI item of the Beck Depression Inventory. RESULTS: Lesions to the left rostrolateral PFC (rlPFC) were associated with a lower risk of SI independent of depression and global functioning. Left rlPFC lesion also reduced abstract reasoning skills, which mediated the lesion effects on suicide ideation. CONCLUSIONS: The left rlPFC plays a crucial role in SI independently of depression and global functioning.

United States Military Service Members Demonstrate Substantial and Heterogeneous Long-Term Neuropsychological Dysfunction after Moderate, Severe, and Penetrating Traumatic Brain Injury.

The objective of the study was to examine long-term neuropsychological outcome after moderate, severe, and penetrating traumatic brain injury (TBI) in U.S. military service members and veterans (SMVs). Eighty-five SMVs with a history of moderate (n = 18), severe (n = 17), or penetrating (n = 26) TBI, or an injury without TBI (i.e., trauma control [TC], n = 24) were assessed five or more years (mean = 69.4 months; standard deviation = 35.6) post-injury. All passed performance validity tests. Participants completed a battery of neurocognitive tests and a personality inventory. Five cognitive domain composites, each composed of four test scores, and an overall test battery mean (OTBM) were computed. The penetrating TBI group performed worse than the TC group and/or the moderate TBI group on most cognitive domains and the OTBM. The severe TBI group also performed worse than the TC group and moderate TBI group on processing speed and the OTBM, and worse than the TC group on attention/working memory. Just more than half of participants with severe (56%) or penetrating (64%) TBI met criteria for mild neurocognitive disorder, with processing speed the most commonly impaired domain. In addition, 80% of TBI participants had one or more clinically elevated scales on the Minnesota Multiphasic Personality Inventory-2-Restructured Form® (MMPI-2-RF), with somatic complaints the most common elevation. In conclusion, there was significantly reduced cognitive and psychological functioning many years after severe and penetrating TBI in SMVs. Cognitive and psychological dysfunction, however, were highly variable, with a substantial minority of SMVs having good outcome. Long-term individualized support is necessary for individuals after moderate, severe, and penetrating TBI.

Multicenter Validation of the Survival After Acute Civilian Penetrating Brain Injuries (SPIN) Score.

BACKGROUND: Civilian penetrating traumatic brain injury (pTBI) is a serious public health problem in the United States, but predictors of outcome remain largely understudied. We previously developed the Survival After Acute Civilian Penetrating Brain Injuries (SPIN) score, a logistic, regression-based risk stratification scale for estimating in-hospital and 6-mo survival after civilian pTBI with excellent discrimination (area under the receiver operating curve [AUC-ROC = 0.96]) and calibration, but it has not been validated. OBJECTIVE: To validate the SPIN score in a multicenter cohort. METHODS: We identified pTBI patients from 3 United States level-1 trauma centers. The SPIN score variables (motor Glasgow Coma Scale [mGCS], sex, admission pupillary reactivity, self-inflicted pTBI, transfer status, injury severity score, and admission international normalized ratio [INR]) were retrospectively collected from local trauma registries and chart review. Using the original SPIN score multivariable logistic regression model, AUC-ROC analysis and Hosmer-Lemeshow goodness of fit testing were performed to determine discrimination and calibration. RESULTS: Of 362 pTBI patients available for analysis, 105 patients were lacking INR, leaving 257 patients for the full SPIN model validation. Discrimination (AUC-ROC = 0.88) and calibration (Hosmer-Lemeshow goodness of fit, P value = .58) were excellent. In a post hoc sensitivity analysis, we removed INR from the SPIN model to include all 362 patients (SPINNo-INR), still resulting in very good discrimination (AUC-ROC = 0.82), but reduced calibration (Hosmer-Lemeshow goodness of fit, P value = .04). CONCLUSION: This multicenter pTBI study confirmed that the full SPIN score predicts survival after civilian pTBI with excellent discrimination and calibration. Admission INR significantly adds to the prediction model discrimination and should be routinely measured in pTBI patients.

Diagnosis and treatment of a penetrating brain injury caused by a welding electrode: A case report.

RATIONALE: Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage. PATIENT CONCERNS: A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region. DIAGNOSIS: According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture. INTERVENTION: After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed. OUTCOMES: After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months. LESSONS: In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.

Penetrating head & neck trauma - Epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a level 1 trauma centre.

INTRODUCTION: Penetrating trauma to the head and neck presents specific clinical challenges. Aetiologies include interpersonal violence, deliberate self-harm and terror-related violence. King's College Hospital is a Major Trauma Centre serving inner-city London boroughs with a high incidence of knife and gun crime. It also received victims of the terrorist attack at London Bridge in June 2017. METHODS: Data was collected prospectively on all patients presenting with penetrating trauma to the head and neck over a one-year period (August 2016-July 2017). RESULTS: Overall figures for penetrating trauma are the highest since comparable records began with 478 cases (2016/17) compared with 172 (2010/11). Most patients had injuries resulting from interpersonal violence (83%); a group consisting mostly in males (88%) under the age of 30 (69%). The sole fatality among all patients was a result of repeat deliberate self-harm. Terror-related violence victims were equally gender split and older; all patients in this group required surgical intervention and had longer lengths of stay (16.3 days) compared with interpersonal violence (6.3 days) and deliberate self-harm (3 days). CONCLUSION: Violent crime is increasing. Overall penetrating injury has more than doubled in 6 years. The injury characteristics observed are distinct depending on the assailants and motives. Head and neck trauma requires a multidisciplinary approach, with an understanding of the care needs of patients. Interpersonal violence is the most common aetiology and as such efforts to tackle rising violent crime must involve police and the community. In addition, terror-related violence is evolving in the United Kingdom and globally, and as such healthcare professionals must understand differences in aetiologies to promote optimal patient care.

Managing military penetrating brain injuries in the war zone: lessons learned.

OBJECTIVEManaging penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.METHODSThis study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.RESULTSThere were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.CONCLUSIONSManaging military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.

On a knife-edge: clinical uncertainty with an extensive knife blade in situ in the craniofacial region.

A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient. However, once the extent of the injury was established, ophthalmology requested further review from maxillofacial, ENT and neurosurgery. This resulted in an 84 hours wait between the initial injury and the removal of the knife blade. Incredibly, the patient had no initial sequelae from such an extensive injury and had an unremarkable recovery with no further complications aside from a laceration to the left inferior rectus muscle that was conservatively managed.

Mortality Following Hospital Admission for US Active Duty Service Members Diagnosed With Penetrating Traumatic Brain Injury, 2004-2014.

OBJECTIVE: To examine mortality among active duty US military service members (SMs) with the diagnosis of penetrating traumatic brain injury (PTBI) and a hospital admission between 2004 and 2014. DESIGN: Data on SMs with PTBI and an admission to a military or civilian hospital were obtained from the 2004 to 2014 Military Health System data repository. After applying exclusion criteria, data on 1226 SMs were analyzed. MAIN MEASURES: The number of observed deaths per 100 identified patients with PTBI and time to death from admission were used as main measures. RESULTS: Approximately 25% of the 1226 patients with PTBI included in this study died following admission, with 44.6% of the all deaths occurring within a day following hospital admission and 75% occurring within the first week. Severe comorbid conditions and intentionally self-inflicted injuries are associated with higher mortality rate. SMs' gender, age, year of hospital admission, and service were significantly associated with likelihood of death following PTBI hospitalization. Males had a higher likelihood of dying following hospital admission compared with females (odds ratio = 2.7, confidence interval = 1.03-7.9). SMs in the 35- to 44-year-old and 45- to 64-year-old groups had up to a 2.6 times higher odds of death following their admission compared with the 25- to 34-year-old group. Age, admission year, service, and rank were significantly associated with SMs' time to death from hospitalization. Patients between the ages of 45 and 64 years were significantly more likely to die earlier than other age groups. Furthermore, cases in the Navy Afloat group had a higher fatality rate and were more likely to die earlier than patients in other services. PTBI comorbid conditions and injury type did not significantly affect time to death. CONCLUSION: This study quantifies case fatality rate among hospitalized US SMs with the diagnosis of PTBI. We report a 23.1% crude case fatality rate among the current cohort. Early intensive care for these patients may be the key to improving survival rates.

External Ventricular Drainage Preceding the Removal of a Nail from the Intracranial Space as a Safe Management Strategy for Predicted Secondary Intraventricular Hemorrhage.

BACKGROUND: Intracranial nail gun injury is a rare traumatic event and can result from a suicide attempt. Cerebral angiography is essential in the evaluation of damage to the intracranial vessels, and surgical removal of nails is generally the optimal treatment. Intraventricular hemorrhage can happen after removal of intracranial nails. Endovascular surgery or intraoperative computed tomography has been reported to be useful for detection and treatment of intraventricular hemorrhage. After the surgical removal of nails, attention should be paid for complications such as pseudoaneurysm and infection. CASE DESCRIPTION: A 63-year-old man with a history of depression was transferred to our hospital in an unconscious state. Physical examination showed 2 nails puncturing his left thorax, and computed tomography revealed a nail puncturing the intracranial space. No damage to these intracranial vessels was observed on computed tomography angiography and venography. After drainage for potential intraventricular hemorrhage, the nails were removed. Postoperatively, prophylactic antibiotic therapy was administrated for secondary infection. Computed tomography angiography did not detect any postoperative pseudoaneurysms. The patient also underwent therapy from a psychiatrist and was transferred to another hospital. CONCLUSIONS: As for treatment of a case of intracranial nail gun injury, our case shows that preoperative cerebral angiography is not always needed in intracranial nail gun injury when there is no apparent damage to the intracranial vessels and emergent removal of nails is required. External ventricular drainage preceding the removal of a puncture object can be an effective management strategy for secondary intraventricular hemorrhage.

One and a half syndrome following penetrating head injury: Case report.

The authors report a case of a 22-year-old otherwise healthy female who presented following a head injury during a bar altercation, with no associated loss of consciousness and an unknown mechanism of injury. Examination revealed an isolated 1cm laceration on the right upper eyelid, superior to her medial canthus. She experienced diplopia on right horizontal gaze due to a left internuclear ophthalmoplegia (INO) with an associated left conjugate horizontal gaze palsy, collectively described as a left one-and-a-half syndrome. CT and MRI demonstrated evidence of a deep penetrating injury above the right medial canthus, traversing the ethmoid and sphenoid sinuses, the dorsum sella, narrowly missing the basilar artery, penetrating the pons, and extending to the floor of the contralateral fourth ventricle. The patient was diagnosed with multiple sinus fractures, lesions in her left paramedian pontine reticular formation (PPRF) and medial longitudinal fasciculus (MLF), and progressive pneumocephalus. She underwent a transsphenoidal endoscopic repair via a vascularized mucosal flap without complication. Postoperatively, the patient's pneumocephalus resolved and her conjugate gaze markedly improved; however, minimal diplopia remained. This case demonstrates the importance of the clinical exam, and its benefit in localizing imaging findings and guiding treatment.

Amelioration of Penetrating Ballistic-Like Brain Injury Induced Cognitive Deficits after Neuronal Differentiation of Transplanted Human Neural Stem Cells.

Penetrating traumatic brain injury (PTBI) is one of the major cause of death and disability worldwide. Previous studies with penetrating ballistic-like brain injury (PBBI), a PTBI rat model revealed widespread perilesional neurodegeneration, similar to that seen in humans following gunshot wound to the head, which is unmitigated by any available therapies to date. Therefore, we evaluated human neural stem cell (hNSC) engraftment to putatively exploit the potential of cell therapy that has been seen in other central nervous system injury models. Toward this objective, green fluorescent protein (GFP) labeled hNSC (400,000 per animal) were transplanted in immunosuppressed Sprague-Dawley (SD), Fisher, and athymic (ATN) PBBI rats 1 week after injury. Tacrolimus (3 mg/kg 2 days prior to transplantation, then 1 mg/kg/day), methylprednisolone (10 mg/kg on the day of transplant, 1 mg/kg/week thereafter), and mycophenolate mofetil (30 mg/kg/day) for 7 days following transplantation were used to confer immunosuppression. Engraftment in SD and ATN was comparable at 8 weeks post-transplantation. Evaluation of hNSC differentiation and distribution revealed increased neuronal differentiation of transplanted cells with time. At 16 weeks post-transplantation, neither cell proliferation nor glial lineage markers were detected. Transplanted cell morphology was similar to that of neighboring host neurons, and there was relatively little migration of cells from the peritransplant site. By 16 weeks, GFP-positive processes extended both rostrocaudally and bilaterally into parenchyma, spreading along host white matter tracts, traversing the internal capsule, and extending ∼13 mm caudally from transplantation site reaching into the brainstem. In a Morris water maze test at 8 weeks post-transplantation, animals with transplants had shorter latency to platform than vehicle-treated animals. However, weak injury-induced cognitive deficits in the control group at the delayed time point confounded benefits of durable engraftment and neuronal differentiation. Therefore, these results justify further studies to progress towards clinical translation of hNSC therapy for PTBI.

The Transcranial Stab Wound and the Life-Saving Zygomatic Arch Clinical Report.

A 58-year-old man presented to the neurosurgical emergencies for a transzygomatic transcranial stab wound with a retained broken knife. The patient was neurologically intact. After radiographic evaluation the knife was found to be penetrating the temporal lobe, neighboring the intracavernous portion of the carotid artery. The patient was successfully managed in a conservative way. No abnormalities were seen at 12 months of follow-up. Dealing with penetrating head injuries is a usual condition in neurosurgical practice. Some situations are though really challenging, especially when the offending object is still in place, with a close connection to vital structures. This clinical reports an unusual penetrating head injury, highlighting the importance of careful radiographic evaluation and trying to discuss clear management options.

Trauma intracraneal penetrante trans-orbitario: anatomía relevante, las dinámicas del trauma y los puntos clavepara el tratamiento / Trans-orbital intracranial penetrating trauma: relevant anatomy, trauma dynamics and treatment key points

Las lesiones intracraneales penetrantes trans-orbitarias representan pocos casos de todos los Traumas Craneo-encefálicos, sin embargo, representan del 25 al 50 por ciento de todos los traumas penetrantes craneales. Este tipo de traumas trans-orbitarios se han reportado por diferentes tipos de objetos, incluyendo objetos de metal y de madera. Muchos de estos traumas intracraneales pueden pasar desapercibidos en casos donde el material que ingresa no queda expuesto posterior al trauma y cuando no se presenta lesión neurológica que requiera examinación exhaustiva adicional con neuro-imágenes.

Trans-orbital penetrating intracranial injuries represent few cases of all Traumatic Brain Injuries, although they represent between 25 to 50 percent of all penetrating brain injuries. Trans-orbital intracranial penetrating injuries have been reported caused by different types of objects, including metal and wooden objects. Many of these intracranial traumas can be dismissed, especially in those cases where the material is not exposed after the injury and there is no need of further examination with neuroimaging in absence of neurological deficit.

Predicting survival after acute civilian penetrating brain injuries: The SPIN score.

OBJECTIVE: To identify predictors associated with survival in civilian penetrating traumatic brain injury (pTBI) utilizing a contemporary, large, diverse 2-center cohort, and to develop a parsimonious survival prediction score for pTBI. METHODS: Our cohort comprised 413 pTBI patients retrospectively identified from the local trauma registries at 2 US level 1 trauma centers, of which one was predominantly urban and the other predominantly rural. Predictors of in-hospital and 6-month survival identified in univariate and multivariable logistic regression were used to develop the simple Surviving Penetrating Injury to the Brain (SPIN) score. RESULTS: The mean age was 33 ± 16 years and patients were predominantly male (87%). Survival at hospital discharge as well as 6 months post pTBI was 42.4%. Higher motor Glasgow Coma Scale subscore, pupillary reactivity, lack of self-inflicted injury, transfer from other hospital, female sex, lower Injury Severity Score, and lower international normalized ratio were independently associated with survival (all p < 0.001; model area under the curve 0.962). Important radiologic factors associated with survival were also identified but their addition to the full multivariable would have resulted in model overfitting without much gain in the area under the curve. CONCLUSIONS: The SPIN score, a logistic regression-based clinical risk stratification scale estimating survival after pTBI, was developed in this large, diverse 2-center cohort. While this preliminary clinical survival prediction tool does not include radiologic factors, it may support clinical decision-making after civilian pTBI if external validation confirms the probability estimates.

Neurological findings in pediatric penetrating head injury at a university teaching hospital in Durban, South Africa: a 23-year retrospective study.

OBJECTIVES Penetrating traumatic brain injuries (TBIs) can be divided into gunshot wounds or stab wounds based on the mechanisms of injury. Pediatric penetrating TBIs are of major concern as many parental and social factors may be involved in the causation. The authors describe the penetrating cranial injuries in pediatric patient subgroups at risk and presenting to the Department of Neurosurgery at the University of KwaZulu-Natal, by assessment of the Glasgow Coma Scale (GCS) score and review of the common neurological manifestations including cranial nerve abnormalities. METHODS The authors performed a retrospective chart review of children who presented with penetrating TBIs between 1985 and 2007 at a university teaching hospital. Descriptive statistical analysis with univariate and multivariate logistic regression was used to assess the variables. RESULTS Out of 223 children aged 16 years and younger with penetrating TBIs seen during the study period, stab wounds were causal in 127 (57%) of the patients, while gunshot injuries were causal in 96 (43%). Eighty-four percent of the patients were male. Apart from abnormal GCS scores, other neurological abnormalities were noted in 109 (48.9%) of the patients, the most common being cranial nerve deficits (22.4%) and hemiparesis. There was a strong correlation between left-sided stab wounds and development of seizures. The mean age of patients with neurological abnormalities was 11.72 years whereas that of patients with no neurological abnormalities was 8.96 years. CONCLUSIONS Penetrating head injuries in children are not as uncommon as previously thought. There was no correlation between the age group of the patients and the mechanism of injury, which implies that stab or gunshot injuries could occur in any of our pediatric population with the same frequency. While gunshot injuries accounted for 56% of the patient population, stab injuries still accounted for 44%. Following penetrating head injuries, neurological abnormalities tend to occur in the older subgroup of the pediatric patients. The most common neurological abnormalities were hemiparesis followed by cranial nerve deficits. Facial nerve deficits were the most commonly seen cranial nerve abnormality. Immediate convulsions were a significant feature in patients with stab injuries to the head compared to those with gunshot injuries.

[THE TREATMENT OF INJURED PERSONS WITH COMPLICATED PENETRATING THORACIC WOUNDINGS ON TERTIARY LEVEL OF THE MEDICAL CARE DELIVERY].

The results of examination and treatment of 36 injured persons with complicated penetrating thoracic woundings in tertiary centres were analyzed. Own experience of the pulmonary woundings surgical treatment, using application of videothoracoscopic and welding-coagulating equipment, was summarized.