Abstract
Three representative cases of penetrating traumatic brain injury (TBI) are presented. Case 1. A 74-years old male presented with left hemiparesis, depression of alertness, and a laceration on his right upper eyelid. Initial CT revealed linear intracerebral hematoma, as well as an orbital roof depressed fracture. He was diagnosed as penetrating TBI by horticultural support, to evacuate intracerebral hematoma with anterior fossa reconstruction. Case 2. A 33-years old male presented with his right visual impairment after accidental shooting by a nail gun. CT revealed a penetrating TBI through superior orbital fissure by the nail. Since venous injury was suggested by cerebral angiogram, orbito-zygomatic craniotomy was performed to remove it. Case 3. A 53-years old male had a couple of episodes of penetrating injury at the same portion of the scalp by a needle or by a nail. He came to our hospital for the third episode of a nail wound on the same portion of the scalp. CT revealed transcranial penetrating TBI by the nail. Since cerebral angiogram suggested injuries of both superior sagittal sinus and anterior cerebral artery, the nail was removed under craniotomy. Cautionary notes of the primary care, diagnosis, and management of penetrating TBI are discussed.
