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Unusual spinal cord injury by a speargun
Surg Neurol 1983;20:57-8
57
Unusual Spinal Cord Injury by a Speargun Erdem Tungbay, izzet Ovtil, and Mehmet Zileli Department of Neurosurgery, Aegean University, Izmir, Turkey Tungbay E, Ov/il L Zileli M. Unusualspinal cord injury by a speargun. Surg Neurol 1983;20:57-8. Penetrating injury of the upper cervical spinal cord is usually caused by missiles. An unusual case of injury to the upper cervical spinal cord by a speargun is reported. Surgical treatment was uneventful, and the patient made good neurological progress within 2 days after the operation. On the fifth day he became confused and had a temperature of 40°(7. A diagnosis of Branhamella catarrhalis meningitis was made. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury. KEYWORDS: Spinal cord injury; Speargun; Branhamella catarrhalis; Meningitis
Penetrating injury of the spinal cord is usually caused by missiles [3]. To our knowledge an upper cervical spinal cord injury by a speargun has not previously been reported. In this report, a case of such unusual injury is described.
Case R e p o r t A 3 5-year-old man was admitted to our hospital in June 1982. According to his wife he shot himself accidentally with a speargun. A single-point spear with shaft had penetrated through the anterior part of the neck under the right mandible, and the tip of the spear was visible on the right side of the external occipital protuberance. The patient had initially been admitted to the emergency room, where tracheostomy and exploration of the neck were made. The operation was unsuccessful; the surgeon simply unscrewed the spear shaft, which measured about 100 cm in length, and left the single-point spearhead in place (Figure 1). The patient was transferred to our department a day later. On admission he stated that after the injury he had immediate and complete paralysis of the right side. Address reprint requests to: Dr. Erdem Tun~bay, Department of
Neurosurgery, Aegean University,Bornova, Izmir, Turkey. © 1983by ElsevierSciencePublishingCo.,Inc.
On examination he was alert and well oriented. The neck was fixed, and he was unable to move it. There was a small laceration in the oropharynx. Neurological examination revealed complete sensorimotor paralysis of the right side except for position and vibration sensation. Babinski responses were present on the right, superficial abdominal side, and the cremasteric reflexes were absent on that side. There was an incomplete loss of sensation on the left side. Routine x-ray films showed a 13-cmlong, single-point spearhead on the right side of the neck (Figures 2 and 3). During the second operation the carotid artery, the larynx, and the hyoid bone were carefully exposed. The anterolateral surfaces of the second, third, and fourth cervical vertebrae were palpated. A very small laceration of the prevertebral fascia was seen, and the tip of the spearhead was felt inside this lacerated area. This heavy, single-point spearhead was embedded and fixed firmly to the right side of the vertebral body. The spearhead was extracted by gentle, forceful traction. A large quantity of cerebrospinal fluid drained from the opening. The wound was closed in layers, and drains were left in place. The course after the operation was uneventful. Treatment consisted of triple antibiotics, dexamethasone, and early rehabilitation. The patient made good neurological progress. Within 2 days, he was able to move his arm and leg. On the fourth day following the operation, however, he was febrile and lethargic. On the fifth day, examination revealed definite rigidity of the neck and a temperature of 40°C. Lumbar puncture examination of the cerebrospinal fluid revealed a very high pleocytosis, and cultures of the fluid identified a Neisseria type of bacteria. Further microbiologic cultures of the fluid isolated Branhamella catarrhalis as the causative organism of this meningitis. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury.
Discussion Stab wounds of the spinal cord by knives, screwdrivers, and needles have been described previously [1,2]. To our knowledge, injury of the upper cervical spinal cord 0090-3019/83/$3.00
58
Surg Neurol 1983;20:57-8
Tun~bay et al
Figure 2. X-ray film taken before the second operation, showing the spearhead on the right side of the neck.
Figure 1. X-ray film taken before the first operation, showing the spearhead with shaft on the right side of the neck.
Figure 3. The spearhead removedfrom the patient.
by a speargun has not been reported previously. According to the patient's wife this was an accidental injury, but a suicide attempt should also be considered. The postoperative complication of Branhamella catarrhalis meningitis probably originated from the laceration of the oropharynx and the connection between the subarachnoid space and the oral cavity.
References 1. Kondo A, Koyama T, IshikawaJ, Yamasaki T. Injury to the spinal cord produced by acupuncture needle. Surg Neurol 1979;11: 155-6. 2. Lipschitz R. Stab wounds of the spinal cord. In Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology, Vol 25. Amsterdam: North-Holland Publishing Company, 1976:197-207. 3. Yashon D, JaneJA, White RJ. Prognosis and management of spinal cord and cauda equina bullet injuries in 65 civilians. J Neurosurg 1970;32:163-70.
57
Unusual Spinal Cord Injury by a Speargun Erdem Tungbay, izzet Ovtil, and Mehmet Zileli Department of Neurosurgery, Aegean University, Izmir, Turkey Tungbay E, Ov/il L Zileli M. Unusualspinal cord injury by a speargun. Surg Neurol 1983;20:57-8. Penetrating injury of the upper cervical spinal cord is usually caused by missiles. An unusual case of injury to the upper cervical spinal cord by a speargun is reported. Surgical treatment was uneventful, and the patient made good neurological progress within 2 days after the operation. On the fifth day he became confused and had a temperature of 40°(7. A diagnosis of Branhamella catarrhalis meningitis was made. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury. KEYWORDS: Spinal cord injury; Speargun; Branhamella catarrhalis; Meningitis
Penetrating injury of the spinal cord is usually caused by missiles [3]. To our knowledge an upper cervical spinal cord injury by a speargun has not previously been reported. In this report, a case of such unusual injury is described.
Case R e p o r t A 3 5-year-old man was admitted to our hospital in June 1982. According to his wife he shot himself accidentally with a speargun. A single-point spear with shaft had penetrated through the anterior part of the neck under the right mandible, and the tip of the spear was visible on the right side of the external occipital protuberance. The patient had initially been admitted to the emergency room, where tracheostomy and exploration of the neck were made. The operation was unsuccessful; the surgeon simply unscrewed the spear shaft, which measured about 100 cm in length, and left the single-point spearhead in place (Figure 1). The patient was transferred to our department a day later. On admission he stated that after the injury he had immediate and complete paralysis of the right side. Address reprint requests to: Dr. Erdem Tun~bay, Department of
Neurosurgery, Aegean University,Bornova, Izmir, Turkey. © 1983by ElsevierSciencePublishingCo.,Inc.
On examination he was alert and well oriented. The neck was fixed, and he was unable to move it. There was a small laceration in the oropharynx. Neurological examination revealed complete sensorimotor paralysis of the right side except for position and vibration sensation. Babinski responses were present on the right, superficial abdominal side, and the cremasteric reflexes were absent on that side. There was an incomplete loss of sensation on the left side. Routine x-ray films showed a 13-cmlong, single-point spearhead on the right side of the neck (Figures 2 and 3). During the second operation the carotid artery, the larynx, and the hyoid bone were carefully exposed. The anterolateral surfaces of the second, third, and fourth cervical vertebrae were palpated. A very small laceration of the prevertebral fascia was seen, and the tip of the spearhead was felt inside this lacerated area. This heavy, single-point spearhead was embedded and fixed firmly to the right side of the vertebral body. The spearhead was extracted by gentle, forceful traction. A large quantity of cerebrospinal fluid drained from the opening. The wound was closed in layers, and drains were left in place. The course after the operation was uneventful. Treatment consisted of triple antibiotics, dexamethasone, and early rehabilitation. The patient made good neurological progress. Within 2 days, he was able to move his arm and leg. On the fourth day following the operation, however, he was febrile and lethargic. On the fifth day, examination revealed definite rigidity of the neck and a temperature of 40°C. Lumbar puncture examination of the cerebrospinal fluid revealed a very high pleocytosis, and cultures of the fluid identified a Neisseria type of bacteria. Further microbiologic cultures of the fluid isolated Branhamella catarrhalis as the causative organism of this meningitis. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury.
Discussion Stab wounds of the spinal cord by knives, screwdrivers, and needles have been described previously [1,2]. To our knowledge, injury of the upper cervical spinal cord 0090-3019/83/$3.00
58
Surg Neurol 1983;20:57-8
Tun~bay et al
Figure 2. X-ray film taken before the second operation, showing the spearhead on the right side of the neck.
Figure 1. X-ray film taken before the first operation, showing the spearhead with shaft on the right side of the neck.
Figure 3. The spearhead removedfrom the patient.
by a speargun has not been reported previously. According to the patient's wife this was an accidental injury, but a suicide attempt should also be considered. The postoperative complication of Branhamella catarrhalis meningitis probably originated from the laceration of the oropharynx and the connection between the subarachnoid space and the oral cavity.
References 1. Kondo A, Koyama T, IshikawaJ, Yamasaki T. Injury to the spinal cord produced by acupuncture needle. Surg Neurol 1979;11: 155-6. 2. Lipschitz R. Stab wounds of the spinal cord. In Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology, Vol 25. Amsterdam: North-Holland Publishing Company, 1976:197-207. 3. Yashon D, JaneJA, White RJ. Prognosis and management of spinal cord and cauda equina bullet injuries in 65 civilians. J Neurosurg 1970;32:163-70.