Left vertebral artery injury and cervical fracture from a cervical puncture wound caused by a pencil: pediatric case report

Abstract

A 10-year-old girl fell indoors and her pencil stuck in her neck. She was admitted to our hospital, and contrast-enhanced computed tomography revealed left vertebral artery injury and fracture of the 7th cervical vertebra. We immediately performed balloon-assisted coil embolization on the proximal left vertebral artery, removed the pencil from her neck, and manually applied direct pressure to achieve hemostasis. The pencil lead had broken and remained inside the vertebra, so we administered antibiotics for one month after the operation to prevent infection. In this case, foreign body removal was performed after prior catheter embolization of the vertebral artery for a good prognosis. In Japan, four cases of vertebral artery injury from a stick wound have been reported in the past. Vertebral artery injury due to cervical puncture requires a therapeutic strategy （such as balloon-assisted embolization） to prevent hemorrhage and cerebral infarction from embolism during removal of foreign objects.