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TRANSCRANIAL STAB WOUNDS: MORBIDITY AND MEDICOLEGAL AWARENESS.

TRANSCRANIAL STAB WOUNDS: MORBIDITY AND MEDICOLEGAL AWARENESS.

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TRANSCRANIAL STAB WOUNDS: MORBIDITY AND MEDICOLEGAL AWARENESS.

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  1. TRANSCRANIAL STAB WOUNDS: MORBIDITY AND MEDICOLEGAL AWARENESS.

  2. NABIL HASSAN M.KHALILEmeritus Professor in Neurosurgery  DepartmentFaculty of Medicine Suez Canal University ,IsmailiaHonorary president of ESNSChief of Egyptian accreditation council for assigning neurosurgery university staffsEgyptTel.+20663234244, Mobile.+20103732045Email: nabilkh@hotmail.com

  3. INTRODUCTION

  4. In the 20th century, stab wounds of the skull and brain have become extremely uncommon. Most of the series reported come from South Africa. These studies draw attention to the pathology, anatomical features, and treatment of transcranial stabs. Unlike craniocerebral missile injuries, low velocity penetrating stab wounds damage a focal area along the tract. Thus the mechanisms of neuronal and vascular damage differ from other types of head injuries. The present study highlights the importance of distinguishing these wounds as an entity.

  5. Cases of the frontal region :

  6. Cases of the frontal region Case (2). Plain x-ray skull showing slot fracture in the left frontal region

  7. Con. Case 2. Case 2. CT scan following a left frontal stab and weapon withdrawal demonstrates a skull fracture with an in-driven fragment and pneumocephalus. There is minimal hemorrhage along the tract.

  8. Diagrammatic picture of the anatomy of the vital structures involved in the temporal stabs.

  9. Cases of the temporal stabs :

  10. Cases of the temporal region : Case 3. This patient was attacked with a pointed metal bar that penetrated deeply in the brain till the diencephalon. The bar was removed emergently but the patient died 2 days after the accident.

  11. Con. Cases of the temporal region : Case 4. This patient was stabbed by screw driver, immediate CT brain revealed LT. Temporal Intracerebral hematoma extending to LT. Lateral ventricle.

  12. Con. Case 4: Case 4. Follow up CT one month later revealed complete absorption of the hemorrhage and remained encephalomalacia through out the tract injury.

  13. Con. Cases of the temporal region : Case 5. CT brain showing deep tract lesion through left temporal stab with knife (withdrawn by the assailant). Patient was deeply comatosed and died 2 hours after admission.

  14. Con. Cases of the temporal region : Case 6. This patient was stabbed in the temporal area with a knife, plain x-ray skull, lateral view, confirmed intracranial penetration of the knife.

  15. Con. Case no.6 : Case 6. A-P view of skull x-ray of the same patient confirmed intracranial penetration of the knife.

  16. Cases of the orbital region:

  17. Cases of the orbital region: Case 7. This boy was stabbed in his Rt.. Orbit and carotico-cavernous fistula developed one month from the injury causing Rt.. Proptosis.

  18. Con. Cases of the orbital region : Post -operative picture of the same previous patient of the Rt.. Orbital trauma

  19. Con. Cases of the orbital region trauma. Case 8. CT brain of a patient suffering Lt.. Proptosis one month after left transorbital stab.

  20. Con. Cases of orbital stab : Case 8.Pre operative angiogram of the same previous patient showing the carotico-cavernous fistula

  21. Con. Case no.8, orbital stab. Case 8. Post-operative angiogram, showing disappearance of the left carotid and muscle embolization through the left cervical common carotid.

  22. CONCLUSION

  23. In this series of eight patients with transcranial stab wounds, the importance of classification of such wounds as a separate traumatic entity is stressed. The mechanisms of neuronal and vascular damage in these wounds are discussed and are found to be specific from other head injuries. Cerebral injury by stabbing is largely restricted to the wound tract. Frontal stabs (2 cases) are accompanied by the least morbidity and mortality, where temporal stabs (4 cases), are commonly fatal. In Trans-orbital stabs (2 cases), carotid-cavernous fistulae resulted. Early recognition, administration of anti-tetanus serum and anti-biotics, and debridement may minimize complications.

  24. MEDICOLEGAL IMPORTANCE Early recognition of stab wounds of the brain is essential to ensure early treatment and optimal outcome. Nevertheless, recognition remains difficult if the weapon has been withdrawn and hence the medicolegal importance.

  25. THANK YOU

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