The following ten irredeemably fascinating and 100% true patient case studies are brought to you by an evening spent following the scientific trail of four deceptively simple search terms: “unusual,” “penetrating,” “craniocerebral,” and “injury.” They are reported in roughly ascending order of gruesomeness:
1. A Pair of Disposable Wooden Chopsticks
While eating cotton candy, a 6-year-old girl fell with a pair of half-split disposable wooden chopsticks in her mouth (it’s not clear whether the chopsticks were being used as the handle of the cotton candy or were in her mouth for some other purpose, but either way, I sort of relate. Cotton candy makes me reckless and uncoordinated, too). Three weeks after the offending utensil was removed from her soft palate (it had penetrated as far as the medulla oblongata, or the lower brain stem), the little one was discharged, apparently free from ill-effect.
2. An Artist’s Paintbrush
A 49-year-old Native American man presented himself at the hospital with a minor headache, some swelling around the eye, and a small cut on his cheek. He said he’d been punched in the left eye—but what he didn’t say was that his assailant must have been a formidable, and truly furious, artist. A CT scan revealed a foreign body lodged in his brain (apparently having gone unnoticed by the man himself for some six hours). It turned out to be “a 10.5 cm long paintbrush, which had penetrated from the left orbit to the right thalamus.” This patient, too, made a complete recovery after the object was removed. The brush was also unharmed by the incident—the authors report that “the hairs from the paintbrush were sent for microbiology culture (but remained sterile).”
3. A Metal Key
A 71-year-old woman was answering a ring at her door when she “misjudged the step and fell forward, impaling herself on the large key protruding from the lock. Here she remained, fully conscious, until the ambulance crew were able to remove her with the key in situ.” The fun thing about this particular paper is that the authors muse on the difference between penetrating head injuries caused by missiles (like guns), where extensive damage is caused by the high-impact trajectory of the wound, and this one, where the patient’s own weight forced the key through her skull—a distinction, I suppose, that probably saved her brain.
The woman, we are told, “recovered nicely.” I imagine that she invested in a pretty little wooden key bowl after that.
This paper reports the cases of two little boys under three years of age, who, in separate incidents, were admitted to the Emergency room with the pins of electrical main plugs embedded in their scalps. Ouch. They both fell from their beds onto the plugs, both escaped with no serious long-term deficits, and, one assumes, failed to complete the circuit required to turn on either appliance.
“We present the case,” write the authors of this paper, “of an 18-month-old girl who fell off a chair whilst at home onto a wooden arch that was decorated with a row of fairy lights. She landed head first on top of the arch. She did not lose consciousness and stopped crying after a few moments. Her parents noticed one of the light bulbs was missing along the arch.” (emphasis mine)
I am not quite understanding how a wooden arch could possibly be below a chair onto which a little girl could have climbed, but never mind that. What I really want to tell you is that her doctors titled their article “An Unusual Case of Lightheadedness.” Everyone’s a comedian.
(Yes, the lightbulb was removed, and the patient recovered beautifully, thus avoiding a lifetime’s worth of “and then the light bulb went on” jokes.)
6. THE BLADE OF A FAN AGH
Is it getting harder and harder for you to believe the words “recovered uneventfully”? Because it is for me. This poor 7-year-old Indian girl accidentally bumped into a pedestal fan that was on, rotating, and unprotected by a mesh cover, as a result becoming impaled in the head by one of the fan’s metal blades. And yet. “Recovered uneventfully.” The human head is an amazing thing.
7. A Snooker Cue
(For those of you who aren’t British or from an ex-colonial territory, snooker is like pool, but with a bigger table, slightly different rules, and smaller balls. Ahem.)
“A young man playing snooker was awaiting his turn, holding the cue with the butt resting on the floor, when he was playfully punched in the stomach by an opposing team member. He doubled up and the tip of the cue penetrated his upper eyelid. He removed the cue and attended the casualty department unaided.”
Later, however, the brain damage this patient sustained resulted in his becoming paralyzed on one side of his body. All I have to say about this one is that I used, when I was much younger, to be the kind of person who might occasionally “playfully punch” people, and boy am I glad I never enjoyed snooker.
I like this little set of twin case reports. It describes two patients from the 1960s, one British man and one woman, both involved in “street fights” (not with each other)—at least one of which took place “outside a public house.” In both instances, their assailants were presumably female, and wearing lethally sharp stiletto heels. Both victims suffered penetrating skull fractures that took a while to kick in, with the man becoming temporarily epileptic and the woman temporarily hemiplegic. But within weeks, both made—say it with me—complete recoveries.
9. A Child’s Toothbrush
I include this case even though it involved an injury to the pharynx, not the brain, because truly, it shakes the reader to her soul.
A 10-year-old girl was having her teeth brushed by her mother when she lost consciousness and collapsed from unknown cause(s). The toothbrush snapped, and its head (which was thought to be inside the girl’s mouth) disappeared. Although the girl soon recovered consciousness, she remained drowsy and could not speak.
The missing toothbrush head was not found inside the mouth. Visual inspection of the oral cavity and the pharynx was unremarkable. No sign of injury such as laceration, abrasion, contusion, or bleeding was noticed inside the oral cavity. At that point, we presumed that the toothbrush head had been swallowed or aspirated.
Urgent computed tomography (CT) showed that the toothbrush head had penetrated the right parapharyngeal space and reached as deep as the vicinity of the right internal carotid artery.Nasopharyngoscopy through the nose showed a toothbrush piece lodged in the upper oropharynx that pulsated in a synchronized rhythm with the heartbeat.
Pulsated in a synchronized rhythm with the heartbeat, people.
10. Human Teeth
I did say this was an escalating list.
A 19-year-old motorcycle rider was brought in, fully conscious and showing no neurological deficits, after a head-on collision with another motorcycle. Neither rider was wearing a helmet. “A noncontrast CT scan head showed left frontal depressed fracture with three hyperdense globular structures in a row in the left frontal region just below the fracture segment. The patient was operated immediately...three foreign bodies, which turned out to be human teeth, (were) removed one by one.”
I think this is a case in which “You should have seen what the other guy looked like” doesn’t really apply.
Addendum I. After I finished researching this piece I discovered that almost exactly two years ago, Neurophilosophy brought us a very similar roundup of unusual penetrating brain injuries. The best part? There’s only one overlap between the two articles. Moral of the story: There are more than enough unusual penetrating brain injury cases for us all.
Addendum II: We couldn’t end this piece without a mention of the über-brain injury patient, Phineas Gage. Mind Hacks reported recently on a new examination of Gage’s case.