An Unusual Case of Penetrating Brain Injury in a Child: A Case Report

Abstract

Background: Penetrating traumatic brain injury (pTBI) is defined as any cranial trauma that disrupts the skull and the protective meningeal barriers, frequently resulting from high-velocity projectiles, sharp object accidents, assaults, or occupational injuries. Although less prevalent than closed head trauma, pTBI carries a significantly poorer prognosis, attributable to the elevated risk of intracranial infection, vascular compromise, and long-term neurological deficits. Methods: We report the case of a 15-year-old female who sustained a penetrating brain injury following a fall from a tree while cutting firewood. During the incident, the machete (“panga”) she was using penetrated the right orbit and traversed intracranially, emerging through the left vertex. Results: At presentation, she had a Glasgow Coma Score of 10 (E4M5V1), had a brief preceding loss of consciousness, approximately 3 minutes, and no seizures. Her vitals were stable. No associated systemic injuries were found. Initial computed tomography (CT) brain confirmed a transcranial foreign body with significant streak artifact obscuring parenchymal evaluation. CT cerebral angiography and venography excluded vascular injury. Definitive management involved a bifrontal craniotomy, meticulous debridement, foreign body extraction, skull base duraplasty, and ophthalmologic evaluation under anesthesia. Postoperatively, the patient exhibited abulia but showed progressive neurological recovery within 2 weeks. She was discharged with a GCS of 15, remained free of cerebrospinal fluid leakage and intracranial infection, having been managed with intravenous broad-spectrum antibiotics for two weeks. Follow-up CT demonstrated only minimal resolving intracerebral hemorrhage around the machete tract. Conclusion: This case highlights the complexity of managing penetrating brain injuries in pediatric patients. Favorable outcomes depend on early recognition, comprehensive imaging, aggressive neurosurgical intervention, and a collaborative multidisciplinary strategy to minimize morbidity and prevent potentially fatal complications.