Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region.

Carlo Brembilla,Emanuele Costi,Elena Moretti,Claudio Bernucci,Gianluigi Dorelli,Luigi Andrea Lanterna,Paolo Gritti

doi:10.1155/2015/623405

Abstract

Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF) sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.

Highlights

Penetrating injury is the third most frequent cause of spinal injuries in adults, only surpassed by traffic accidents and falls [1]
Stab wounds are usually inflicted by knife or other sharp objects
After the self-removal of the foreign object the patient complained of a disabling orthostatic headache

Summary

Introduction

Penetrating injury is the third most frequent cause of spinal injuries in adults, only surpassed by traffic accidents and falls [1]. Gunshot wounds and knife stabbings account for the majority of penetrating spinal injuries [2, 3]. Other rare objects usually cause incidental penetrating spinal injury [4,5,6]. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury to the sacral region. The man was referred to the attention of Pope John XXIII Hospital Emergency Department in Bergamo with a disabling orthostatic headache

Case Report

Discussion