Penetrating head trauma.

Abstract

A 52-year-old female presented to the emergency department (ED) after sustaining an isolated head injury earlier in the day. She was previously healthy with no reported past medical or surgical history and denied any alcohol or drug use. Physical examination was notable for a large (approximately 20 cm) Bhutanese Dart or “Khuru” penetrating into the right preauricular region as depicted in Figure 1. The patient was hemodynamically stable and had a non-focal neurologic examination with a Glasgow Coma Scale of 15. She reported being accidentally struck by a Khuru (made of iron, animal bone, and wood) that missed the intended target and ricocheted off a nearby stone striking her in the head earlier in the day. She was able to make the 2-hour journey to the capital Thimphu without incident and denied any history of loss of consciousness, seizure activity, or vision changes and complained primarily of a severe headache. In the ED, computed tomography imaging was obtained and revealed an approximately 2-cm penetrating dart injury to the temporal skull region with an associated right intracerebral hemorrhage (Figures 2-4). The patient was started on prophylactic antibiotics and phenytoin and under procedural sedation with ketamine, the surgical team removed the dart in the ED (Figures 5, 6). She was admitted to the surgical unit for observation and, after an uncomplicated postoperative course, discharged home on hospital day 2. Follow-up at 6 months revealed a full recovery with no long-term neurologic deficits.