Korean J Neurotrauma.  2016 Oct;12(2):175-179. 10.13004/kjnt.2016.12.2.175.

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

• Han HJ
• Jung JH
• Hong CK
• Kim YB

• KMID: 2356797
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.175

Abstract

Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.

Keyword

Neck injury; Digital subtraction angiography; Multidetector computed tomography

MeSH Terms

Angiography, Digital Subtraction
Emergency Service, Hospital
Hemorrhage
Humans
Middle Aged
Multidetector Computed Tomography
Neck Injuries
Neck*
Neurologic Manifestations
Operating Rooms
Vascular System Injuries
Vital Signs
Wounds, Penetrating

Figure

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  FIGURE 1 Photograph taken in the emergency room. (A) The knife is shown to be penetrating from behind the left mandible (B) toward the occiput.

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  FIGURE 2 (A) Three-dimensional reconstructed computed tomography showing that the knife pierced the paraspinal muscles on the left side and (B) the base of the occipital bone behind the stylomastoid foramen.

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  FIGURE 3 High-resolution computed tomography showing the major vessels (white circle) were a little apart from the blade of the penetrating knife. Internal carotid artery (narrow black arrow), internal jugular vein (white arrow), and vertebral artery (black arrow).

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  FIGURE 4 Injection of the left carotid artery in digital subtraction angiography showed a patent carotid artery; however, it is not clear if foreign material is pressing on the artery. (A) Anterior posterior projection (B), lateral projection.

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  FIGURE 5 On digital subtraction angiography, injection of the left vertebral artery showed this vessel to be patent. (A) Anterior-posterior projection and (B) lateral projection.

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