Cases reported "Wounds, Stab"

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1/58. Access to the traumatized vertebral artery: an unusual approach.

    Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.
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2/58. Unilateral exophthalmos caused by traumatic vertebral artery to vertebral and jugular vein fistula: problems in diagnosis and management.

    skull base venous fistulas are rare. A 15-year-old boy was stabbed in the left side of his neck, just below the mastoid process. Two years later, he presented with a protruded and pulsating left eye with red sclera. A soft murmur was audible all over his head and neck. angiography revealed an arteriovenous fistula between the third portion of the vertebral artery (V3) and the vertebral venous plexus, as well as the ipsilateral jugular vein (VVJF). The fistula recruited several arterial feeders and rising the venous pressure along the outflow system of the skull base had led to unilateral exophthalmos.
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3/58. Suicides by sharp force: typical and atypical features.

    A total of 65 consecutive cases of suicide by sharp force were investigated by evaluating the autopsy and prosecution department records. Suicides constituted 17% of all fatalities from sharp force autopsied between 1967 and 1996. Young males and persons with a psychiatric history predominated among the persons who chose this "hard" method of suicide. The most common implements used were knives (62%) and razor blades (15%). Cutting injuries in isolation were present in 26, stab injuries in isolation in 24 and a combination of both in 15 fatalities. The number of injuries per case varied from 1 to 37 but 1/3 showed one injury. More than 85% of the cutting injuries were located at the wrist, elbow crease or neck whereas 79% of the stab injuries involved the ventral aspect of the trunk. Perforation of clothing was present in 16 (52%) out of 31 stab injuries to the trunk. Injuries to more than one body region were observed in 34 (52%) cases. Tentative marks were present in 50 (77%) fatalities and the number varied from 1 to 60 per case. Superficial incisions of the fingers were found in 15% with razor blades constituting the weapon in half of these cases. Deviations from these typical patterns occurred not infrequently. The utter determination of the victim to carry it through or the use of unusual weapons resulted in a few bizarre cases which are outlined briefly.
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4/58. An unusual stab wound of the cervical spinal cord: a case report.

    STUDY DESIGN: A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported. OBJECTIVE: To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed. SUMMARY OF BACKGROUND DATA: Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from south africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described. methods: An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries. RESULTS: Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations. CONCLUSION: Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.
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5/58. Injury caused by deeply penetrating knife blade lodged in infratemporal fossa.

    Knife-inflicted, deeply penetrating head and neck trauma is an uncommon life-threatening injury and a challenging problem. An examination of the neurovascular and systemic physical status is a first requirement and the decision as to which approach to adopt for the removal of the blade is of critical importance. Here we report a rare case of a pre-auricular stab wound with the knife blade deeply lodged in the extracranial infratemporal fossa. Radiological investigations showed that the knife blade had entered from the temporomandibular joint and become lodged through the anterior margin of foremen magnum below the petrosal bone. Minimal left vocal cord paresis, left palatal weakness and a slight deviation of the tongue towards the left side were observed. The other neurological and systemic physical evaluations were normal. Simple withdrawal of the blade in the operating room did not cause serious neurovascular injury. Here we discuss and compare the expanded exposure of anatomical structures for blade removal and simple withdrawal in similar injuries.
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6/58. Traumatic pseudoaneurysm of the thyrocervical trunk.

    A case of a pseudoaneurysm of the thyrocervical trunk after a pocketknife stab wound to zone I of the neck is reported. The patient was evaluated and treated in an emergency department with irrigation of the wound, bandage, and oral antibiotics. A large pseudoaneurysm slowly developed over the next 2 months. When the patient arrived at our hospital, he was immediately admitted and arteriograms were obtained. Arteriograms revealed an active leak of blood into a pseudoaneurysm from the thyrocervical trunk. Surgical treatment consisted of proximal and distal ligation of the thyrocervical trunk. This is the first case of a pseudoaneurysm developing only from the thyrocervical trunk due to a stab wound to zone I of the neck. This case and its complication serve to illustrate and emphasize the rationale for routinely imaging the great vessels after all penetrating trauma to zone I of the neck.
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7/58. pneumocephalus secondary to a neck stab wound without neurologic injury in a 13-year-old girl.

    pneumocephalus is usually caused by injury that damages the brain meninges and thus allows air to enter the intracranial cavity. Our intention was to establish the importance of considering a stab wound in the neck as a possible cause of traumatic pneumocephalus. The paper presents the case of a 13-year-old girl who was accidentally stabbed in the neck with a kitchen knife by her brother. She had no neurological deficit but had developed headaches. An examination showed cerebrospinal fluid leaking from the neck wound and a CT scan revealed the pneumocephalus. Following surgical treatment, the patient's clinical symptoms regressed. To our knowledge, this case is the first report of the manifestation of pneumocephalus as the result of a neck stab wound in a child; overall, there are only three reported cases of pneumocephalus caused by a neck stab wound.
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8/58. Traumatic Brown-Sequard-plus syndrome.

    BACKGROUND: In the 1840s Brown-Sequard described the motor and sensory effects of sectioning half of the spinal cord. Penetrating injuries can cause Brown-Sequard or, more frequently, Brown-Sequard-plus syndromes. OBJECTIVE: To report the case of a 25-year-old man who developed left-sided brown-sequard syndrome at the C8 level and left-sided horner syndrome plus urinary retention and bilateral extensor responses following a stab wound in the right side of the neck. RESULTS: magnetic resonance imaging demonstrated a low cervical lesion and somatosensory evoked potentials confirmed the clinical finding of left-side dorsal column disturbance. At follow-up, the patient's mobility and bladder function had returned to normal. CONCLUSION: This patient recovered well after a penetrating neck injury that disturbed function in more than half the lower cervical spinal cord (Brown-Sequard-plus syndrome).
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9/58. Endovascular repair of occluded subclavian arteries following penetrating trauma.

    PURPOSE: To describe the endovascular repair of 2 subclavian arteries occluded due to penetrating trauma. case reports: Two male patients were admitted with zone-I neck stab wounds. Both were hemodynamically stable and had absent pulses in the ipsilateral upper limb with decreased Doppler pressures. There were no signs of critical ischemia or active bleeding. On arteriography, complete occlusion of the second segment of the left subclavian arteries in both patients was demonstrated. Stent-graft repair and embolectomy under local anesthesia were successfully performed. No procedure-related complications occurred, and both patients were discharged after 2 days. At 1-year follow-up, stent-graft patency was demonstrated in both patients. CONCLUSIONS: Endovascular repair is a feasible and safe option in the management of occluded subclavian arteries due to penetrating trauma. This may represent another indication for stent-grafting in the expanding role of this technique.
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10/58. suicide by more than 90 stab wounds including perforation of the skull.

    A man committed suicide in his bathroom using a small pocket knife. At the autopsy a total of 92 stab wounds on the forehead, in both temples, the anterior aspect of the neck, the back of the neck, the chest and the sides of the trunk were found. In addition, repeated stabbing had caused a large soft tissue defect on the forehead. The frontal bone showed 3 perforations but no brain injury was present and two ribs were severed in the bony part, one of which carried a star-like pattern from repeated stabbing. No major vessels were injured and the cause of death was exsanguination after a considerable survival time. The large number of stab wounds, the perforation of bone and some injury sites, especially the head and back of the neck, are extraordinary findings in suicides which were probably favoured by insufficient anatomical knowledge and the use of a short-bladed knife. A psychiatric history could not be verified.
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