Attempting homicide by inserting sewing needle into the brain: Report of 6 cases and review of literature

详细信息    查看全文

• 作者：Abbas Amirjamshidi ; Arman Rakan Ghasvini ; Maysam Alimohammadi ; Kazem Abbassioun
• 关键词：Akinetic mutism ; Headache ; Iron rust ; Penetrating head wound ; Sewing needle
• 刊名：Surgical Neurology
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：72
• 期：6
• 页码：635-641
• 全文大小：1099 K

文摘

Background and objectives

Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.

Material and methods

The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed.

Results

Among the 4 patients who underwent surgery, 1 died after a short period of ‘akinetic mutism.’ Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr.

Conclusion

In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life.