Impalement brain injury: report of five consecutive clinical cases

Background The management of impalement brain injury is very challenging, because of its complexity, risk of intracranial infection, neurological damage and functional impairment of the affected persons; in addition to the paucity of standardised treatments guidelines. The objective of this paper was to describe the clinical presentation and management outcome of patients admitted with impalement brain injuries in our centre. Case presentation Data of all patients with traumatic brain injury from January 2015 to November 2018 was collated from hospital medical record department and theatre operation register. Records of patients with impalement brain injury managed within the aforementioned period were extracted. We managed 5 cases (0.26%) of impalement cranio-cerebral injuries out of the total 1913 cases of traumatic brain injury managed over the study period. All the patients were males with a mean age of 28 years. Alteration in the level of consciousness and bleeding scalp wound with impaled object were the main presenting symptoms. Three of the patients were presented in coma. The injury resulted from different causes and variable objects implicated. The impaled objects identified included iron-rod, metallic part of Dane gun, multi-faceted spear, piece of stone and a piece of charred wood. Both the right and left sides of the cranium was equally affected with a case involving midline frontal area. Craniectomy around the impaled object was used to remove the objects, two patients had good recovery whilst three succumbed to the injuries, one died from disseminated intravascular coagulopathy and the two were from aspiration pneumonitis complicated by respiratory failure. Conclusions Impalement cranio-cerebral injury accounted for about 0.3% of all cases of traumatic brain injury in our environment. Variable impaled objects were found affecting a different part of the cranium and postoperative outcome depends largely on the preoperative neurological status.