Abstract
Here we present a very rare case of a woman with a bone fragment in the third ventricle of the brain following compound-depressed skull fractures due to a road traffic accident.There are only few case reports of bullets and textiloma being removed from the third ventricle. Following operative removal of the fragment, the patient was started on cortisol, mineralocorticoid and thyroid hormone replacement. However, the patient eventually died of the severe traumatic hypothalamic insult.
Highlights
We present a very rare case of a woman with a bone fragment in the third ventricle of the brain following compound-depressed skull fractures due to a road traffic accident
The patient was taken for debridement of the wound and craniotomy with retrieval of the bone fragment (Figure 2, Figure 3) following hematoma tracking
On the second post-operative day, the patient was started on ionotropic support because of the refractory hypotension, and was replaced with hydrocortisone, fludrocortisone and thyroid hormones
Summary
As brain abscesses may result from driven bone fragments and other retained foreign bodies in the brain, the removal of readily accessible foreign bodies has received much attention[3,4,5,6]. Migration of foreign bodies can occur because of gravitational force. Monitoring and control of elevated intracranial pressure with maintenance of cerebral perfusion pressure plays a significant role in the patient’s survival and outcome. The follow-up of such patients is essential, considering known complications like cerebrospinal fluid fistula in the early post-operative period and brain abscesses and seizures which may occur years after injury. Outcome after a penetrating head injury is directly related to the Glasgow coma scale at the time of presentation, which is the reflection of the extent of brain tissue damage caused directly by the primary impact. Intensive post-operative monitoring of intracranial pressure, cardio-respiratory function and metabolic status are required for optimizing the outcome of victims of penetrating craniocerebral injuries[12]. Even after timely removal of the penetrating objects and intensive medical management, the outcome may remain poor. Grant information The author(s) declared that no grants were involved in supporting this work
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