Modern Phineas Gage: A Man with a Knife in the Brain

Chon Sum Ong ◽  
Nur Amalina Binti Che Din ◽  
Celine Mien Er Fong ◽  
Amira Nabiha Binti Jamalludin

An accident with a tamping iron made Phineas Gage a historically famous brain-injury survivor. (1) Each year, approximately 1.6 million people sustain traumatic brain injury, leading to 52,000 deaths annually. (2) However, there is limited literature regarding traumatic brain penetration injury that could be found. A 42-year-old male with psychosis forcefully inserted a butter knife through nostril, traversed via sella turcica into posterior corpus callosum in a mental health facility. He was intubated in his local hospital and transferred over to a tertiary hospital for neurosurgical intervention. Radiological imaging showed impingement of knife against the posterior cerebral artery (PCA), multiple brain infarcts, intraventricular, and subarachnoid haemorrhage. The knife was removed after securing the PCA with the collaboration between neurosurgery and interventional radiology team. Sinus repair was immediately performed by the otorhinolaryngologists. External ventricular drain was inserted due to hydrocephalus secondary to brain haemorrhage. He eventually developed ventriculitis leading to sepsis and was treated with multiple antibiotics. The traumatic brain injury led to anterior hypopituitarism and diabetes insipidus which was treated using hormone therapy. He not only survived the fatal brain injury but also regained his Glasgow Coma Scale (GCS) score. This case demonstrates the potential of a multi-disciplinary and specialty approach to achieve outcomes a single specialty team could not. The outcome of a case which was deemed to be a non-survivable brain injury was made different due to the bold decision making, experience and innovative surgical strategy. Future research is needed to better understand and manage brain penetration injury.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S27

Rully Hanafi Dahlan ◽  
Sevline Estethia Ompusunggu ◽  
Ismail M. Baselim ◽  
Yustinus Robby B. G.

Cervical trauma is a serious condition, that may cause permanent disability or even death. Cervical trauma occurs in 2-7% of blunt trauma patients. In Europe, the incidence of cervical trauma is approximately 9-17/100,000 annually,. The most common mechanisms of injury causing cervival trauma are traffic accidents and falls, which the most commonly injured vertebra is vertebral C2 (axis). Diagnostics of cervical trauma are based on good clinical assessment and prompt radiological imaging. Several patient groups, such as the elderly and patients with traumatic brain injury are highly susceptible to cervical trauma. The diagnostics of cervivcal trauma remain challenging for clinical practitioners and failure to diagnose cervical trauma in acute care may have serious consequences.

2016 ◽  
Vol 7 (01) ◽  
pp. 97-101 ◽  
Clifford Chacha Mwita ◽  
Johnstone Muthoka ◽  
Stephen Maina ◽  
Phillip Mulingwa ◽  
Samson Gwer

ABSTRACT Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly attributed to road traffic accidents in resource-poor areas. However, access to neurosurgical care is poor in these settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons. Materials and Methods: A retrospective clinical audit of the initial management of patients with TBI in Thika Level 5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for those below 13 years owing to differences in response to brain trauma in those below this age. Results: Overall, there was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance) had the worst performance in both groups. Conclusion: Poor compliance to audit criteria indicates the low quality of care for patients with TBI in TL5H. Quality improvement strategies with follow-up audits are needed to improve care. There is a need to develop and enforce evidence-based protocols and guidelines for use in the management of patients with TBI in sub-Saharan Africa.

Ogunleye Olabisi Oluwagbeiga ◽  
Ibrahim Shaphat Shuaibu ◽  
Obanife Henry Olayere

Background: Trauma is the leading cause of death among teens and youth in the developing countries. Head injury accounts for nearly onethird of all trauma deaths and is the leading cause of disability and economic loss. The aim was to study the aetiological pattern of head injury and to highlight the burden of the aetiological factors in our setting. Materials and method: A prospective study on patients admitted with traumatic brain injury at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, a tertiary hospital located in North-eastern Nigeria with neurosurgical services being rendered to her primary and referred patients. Data were collected using structured proforma and were analysed using SPSS version 20 software. Descriptive statistics expressed in mean, frequency and percentages. Results: Five hundred and thirty-seven patients were recruited into the study.

2019 ◽  
Vol 35 (4) ◽  
Sarwar Malik ◽  
Zareen Kiran ◽  
Muhammad Owais Rashid ◽  
Minaz Mawani ◽  
Asma Gulab ◽  

Objective: Data regarding the etiology, clinical and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan. Methods: We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between January 2004 and December 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria. Results: Forty-two patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty-seven patients (88.1%) were females. Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate. Conclusions: Non-traumatic hypopituitarism was more common in women, with Sheehan syndrome being the most common cause of hypopituitarism in our study (35.7%). Secondary hypothyroidism was the most common hormonal deficiency. The most commonly reported symptom was weakness. doi: How to cite this:Malik S, Kiran Z, Rashid MO, Mawani M, Gulab A, Masood MQ, et al. Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital. Pak J Med Sci. 2019;35(4):---------. doi: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2021 ◽  
Vol 12 ◽  
pp. 75
Mohammad Ashraf ◽  
Usman Ahmad Kamboh ◽  
Mohammad Zubair ◽  
Kashif Ali Sultan ◽  
Muhammad Asif Raza ◽  

Background: Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view. Methods: A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital’s pediatrics’ anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented. Results: The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic. Conclusion: Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.

Miroslav Fimić ◽  
Igor Meljnikov ◽  
Aleksandar Milojević ◽  
Mladen Karan ◽  
Petar Vuleković ◽  

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