Unwitnessed head trauma: the bamboo did it.

Unwitnessed penetrating head injuries (PHIs) are often challenging. The inability to locate a foreign body should not exclude this diagnosis nor should it delay treatment. Attempts must be made to clarify the mechanism of injury, as this may allow for a better understanding of the patient's condition.

A healthy 10‐year‐old girl suffered an unwitnessed fall at school. Brain computed tomography (BCT) revealed a sphenoid fracture and pneumocephalus (Fig. 1). A small bush with sharp bamboo sticks stained with dried blood was found at school (Fig. 2), suggesting that she probably suffered a PHI through the nostril. The patient was treated with vancomycin and meropenem and underwent surgical repair of the fracture, making a full recovery.

Figure 1

BCT scan showing fracture of the skull base (full arrow), bone fragment (striped arrow), and pneumocephalus (arrow top).

Figure 2

Bamboo sticks stained with blood.

Question: Unwitnessed head trauma: Does the mechanism of injury change the management of the case?

Answer: When a PHI is suspected, BCT should be performed 1, 2 and immediate treatment should be instituted, including prophylaxis with broad‐spectrum antibiotics and surgical repair, depending on the lesion 2.

Conflict of Interest

None declared.

Authorship

RS: Conception of the work; acquisition of data for the work; revising it critically for important intellectual content; final approval of the version to be published. ÂL: Conception of the work; acquisition of data for the work; revising it critically for important intellectual content; final approval of the version to be published. FA: Revising the work critically for important intellectual content; final approval of the version to be published. MA: Revising the work critically for important intellectual content; final approval of the version to be published.