Penetrating Brain Injuries at Assiut University Hospital: One Year Study

Abstract
Background: Penetrating Brain Injury (PBI) is defined as head traumain which a projectile breaches the cranium and dura matter. It is one of the most fatal forms of trauma and many cases die at the site of trauma. For those who survive till hospitalization, the management of penetrating brain injury represents great challenges to medical and surgical providers. Penetrating brain injuries are classified according to projectile velocity into missile and nonmissile injuries.
Aim of Study: Our study discussesclinical-radiological profile and outcome of patients of penetrating brain injuries.
Material and Methods: This is a prospective hospital based study includes 30 patients with penetrating head injuries admitted and managed at Department of Neurosurgery and Trauma Units of Assiut University Hospital through one year from March 2015 to March 2016.
Results: The mean age was 25 years. 27 patients were males (90%). Brainmatter herniation and Cerebrospinal Fluid (CSF) leak was the most common clinical presentation in 28 (93.3%) patients followed by decreasedlevel of consciousness in 26 (86.6%) patients. Multiple lobe injury was noted in 14 (46.6%) patients followed by parietal lobe in 10 (30%) patients. 12 patients died during the hospital stay. Three patients were discharged in GOS-3, 5 in GOS-4, and 10 in GOS-5. Wound infection occurred in3 (10%) patients, and seizure developed in 7 (23.3%) patients.
Conclusion: Penetrating brain injuries are rising issue in our community. It occurs commonly in young adults (20 to 40 year-old agegroup) and occurs more commonly in males. Firearm is the usual mode of injury and carries worse prognosis than other modes of injury. Higher mortality wasobserved among missile injuries compared to non missile injuries. Mostcases presented with brainmatter herniation or CSF leak. Multi lobar injury is themost common finding followed by parietal lobe injury. Aggressive resuscitation is required in cases of PBI. Prognosis of penetrating brain injuries is highly related to post resuscitation GCS.