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Jose Damian Carrillo Ruiz, Gerarado Rivera Silva, Jorge Arizmendi Vargas and Rodrigo bolaños Jimenez
This patient presented with a penetrating brain injury caused by a machete (a sharp instrument used for harvesting plants) in the right frontoparietal area. The entrance-exit mechanism is shown in images A,B and C. Immediately following the attack the patient complained of bleeding from the wound and blurred vision. However, on initial examination his Glasgow Coma Scale score was 14/15, with no focal neurological deficit. The wound was sutured and radiographs showed an oblique skull fracture (arrows of images D & E). Computed tomography of the head showed a large curved cranial fracture (Panel F) and the brain parenchyma was found to be intact. The patient was reassessed in our service one month after the incident. Despite being at risk of vascular complications, cerebrospinal fluid fistulae and bacterial meningitis, he showed only mild sensorial hearing loss in the right ear (as reported in the audiometric evaluation). Penetrating head injuries are quite uncommon in the civilian population; nevertheless they can be produced with a variety of objects in accidents or in violent attacks. The treatment for penetrating head injuries includes the prevention of infection, repair of cerebrospinal fluid fistulae and the control of intracranial pressure and / or bleeding from major vessels.