Penetrating injury of cranium: a case report

A 38 year-old male patient treated for paranoid schizophrenia for five years was found on a chain saw table at his workplace with a great parasagittal, linear active bleeding wound from left occiput to medial portion of left orbita. He was unconscious with a Glascow coma score of 5 points as 1-3-1. Cranial radiographies revealed a bone defect from left occipital region to left medial border of orbita. CT scan showed also a great linear tissue damage involving left lateral ventricle, and an intracerebral hematoma located mainly at left frontoparietal region. An emergent left frontoparietal craniotomy was performed. Four centimetres laterally midline, there was a linear, vertical tissue wound. Hemostasis was achieved at first and intracerebral haematoma evacuated. At one week postoperatively, his eyes started to react to verbal commands. At 7 months postoperatively he was attempting to cooperate with eye movements and writing. He was right hemiplegic, aphasic and on the right side deep tendon reflexes were hyperactive. His Karnofsky score was almost 40 points. Cranial injuries due to chain saw accidents are very rare. Early surgical procedures (incl. decompression) combined with aggressive antibiotherapy seem to have a great survival benefits. However best long- term results show that this type of injuries have a great rate of mortality and morbidity despite all surgical and medical treatment procedures.