Penetrating Traumatic Brain Injury Secondary to a Circular Saw injury: Case report and Literature Review.

Abstract

Introduction: The global incidence of traumatic brain injury (TBI) is estimated to be 27 million per year, disproportionately affecting developing countries. Penetrating head trauma is a fatal type of TBI with a worse prognosis than closed head trauma. We report a case of an adult male with penetrating head trauma secondary to a circular saw with a highly positive outcome. Case report:  A 41-year-old male patient went to the emergency room of Muhimbili Orthopedic Institute with a circular saw fragment on his forehead. The patient had a head injury while cutting timber; the circular saw machine had a flaw and broke down, smacking his forehead. He presented with a 15 second associated loss in consciousness. On examination, he was alert and had a Glasgow coma score of 15/15. An axial computed tomographic (CT) scan performed without contrast revealed a metallic foreign body piercing the cranial cavity with a depth of about 2 cm, anterior to the coronal suture. No hematoma and normal brain parenchyma. Patient had an immediate craniotomy done with 6 burr holes crossing the midline. The patient had his first seizure at 8 months post trauma with good neuropsychological testing. Conclusion: Head trauma secondary to penetrating objects is extremely rare, with highly unfavorable outcomes. The successful management of these patient groups depends on the neurotrauma unit's ability and the cooperation of a multidisciplinary team involving neurosurgeons, emergency physicians, radiologists and anesthesiologists. It is also essential to add that time management, and patient characteristics also play a significant role.