UNUSUAL CAUSES OF HEAD INJURIES

Abstract

Background: Although the patterns of common causes of head injury (HI) are well established all over the world, however, unusual causes of HI, incurred inadvertently to many patients, do occur every now and then.Objective: To bring to the attention of the practicing neurosurgeon the possibility of an unusual pattern of HI. Furthermore, such injuries may endanger the patient's life.Methods: A retrospective study of 30 HI cases encountered by the author between 1986 – 2003. The Accident and Emergency Hospital in Amara, The Teaching Hospital in Basrah, The Neurosurgical Hospital and The Teaching Hospital at Kadhimiyah, Baghdad. All had 3 standard plain skull X-ray projections: postero-anterior, lateral, and Townes views; occasionally, occipito-mental and orthopentgraphic views were done. Although few cases needed conventional angiographic examination, none of them had the test because of the non-availability of the contrast medium. Few patients had computerized tomography (CT) examination. All cases presented before magnetic resonance (MR) imaging was introduced into the country. Results: Different age groups are represented. Although both sexes were affected, however, most of the victims were males (24, 80%), and most injuries were compound and of a penetrating nature; all calvarial regions are represented in this study. There was no death in this series as all patients made, in due course, an excellent recovery.Conclusions and recommendations: Under certain situations, especially when the financial resources are limited, or up-date neuro-imaging machines are unavailable, plain skull X-ray films prove adequate investigative tool disclosing the extent of bony damages and state of penetration. Domestic animals and tools can, un-expectedly, be harmful; an educational program in this respect is helpful. A protective safety helmet may be mandatory in certain professions when the risk of having a HI is likely. Although most of our patients suffered a certain degree of transient morbidity, however, they were back to normal active life. The practicing neurosurgeon may face an unusual type of HI that may constitute a serious threat to the victim's life. Addressing the management of such events, an urgent non-hesitating attitude is to be practiced by following the standard lines of dealing with penetrating injuries.Key words: Unusual causes of head injury, penetrating injury, plain skull X-ray.