J Korean Neurosurg Soc.  2014 May;55(5):293-295. 10.3340/jkns.2014.55.5.293.

Post-Traumatic Cerebral Infarction Following Low-Energy Penetrating Craniocerebral Injury Caused by a Nail

• Chen PC
• Tsai SH
• Chen YL
• Liao WI

• KMID: 2018038
• DOI: http://doi.org/10.3340/jkns.2014.55.5.293

Abstract

Post-traumatic cerebral infarction (PTCI) is a secondary insult which causes global cerebral hypoxia or hypoperfusion after traumatic brain injury, and carries a remarkable high mortality rate. PTCI is usually caused by blunt brain injury with gross hematoma and/or brain herniation. Herein, we present the case of a 91-year-old male who had sustained PTCI following a low-energy penetrating craniocerebral injury due to a nail without evidence of hematoma. The patient survived after a decompressive craniectomy, but permanent neurological damage occurred. This is the first case of profound PTCI following a low-energy penetrating craniocerebral nail injury and reminds clinicians of possibility this rare dreadful complication for care of head-injured patients.

Keyword

Post-traumatic cerebral infarction; Penetrating craniocerebral injury; Nail injury; Decompressive craniectomy; Brain edema

MeSH Terms

Brain
Brain Edema
Brain Injuries
Cerebral Infarction*
Craniocerebral Trauma*
Decompressive Craniectomy
Hematoma
Humans
Hypoxia, Brain
Male
Mortality

Figure

• 

  Fig. 1 A brain non-contrast computed tomography discloses pneumocranium and hypo-attenuation involving the right anterior cerebral artery, middle cerebral artery (asterisk, A) and posterior cerebral artery area (asterisk, A) without hematoma. The CT scan also reveals cerebral edema with effacement of sulci and homogeneously decreased attenuation with loss of the gray-white matter differentiation (arrows, B).

• 

  Fig. 2 The CT angiography reveals intact right anterior cerebral artery (arrow, A), middle cerebral artery (arrowhead, B) and PCA (arrow, B), without vasospasm or extravasations of contrast material or pseudoaneurysm.

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