Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report
Arq. bras. neurocir; 40 (2), 2021
Publication year: 2021
Crossbow injuries to the head have seldom been reported in the literature, and they
represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow
results in an intracranial fragment larger than most high-velocity projectiles, usually
with a lethal outcome.We present the case of a 34-year-oldman who attempted suicide
with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of
entry and a palpable subcutaneous tip in the left parietal region. The emergency team
reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated
and intubated. Computed tomography (CT) imaging scans showed that the arrow
crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral
contusions adjacent to its intracranial path. Careful retrograde removal of the
penetrating arrow was performed in the CT suite, followed by an immediate CT
scan, which excluded procedure-related complications. The patient woke up easily and
was discharged 3 days later withmild left hand apraxia and no other neurologic deficits.
To the best of our knowledge, there are no similar case reports describing both good
clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the
management of each patient is therefore crucial to achieve the best possible outcome
as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.