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2020, Number 1

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Rev Cubana Neurol Neurocir 2020; 10 (1)

Penetrating wound of the skull (Jael syndrome) by cutting weapon

Hodelín TR, Domínguez PR, Miguel MY, Navarro CD, Hodelín FR

Language: Spanish
References: 21
Page: 1-15
PDF size: 425.00 Kb.


ABSTRACT

Objective: To describe the treatment and evolution of a patient with a penetrating wound at the base of the skull.
Clinical case report: A 23-year-old male patient was treated in the emergency department, because of a wound in the left parietooccipital region and with a foreign object in situ. The neurological physical examination with the Glasgow Coma Scale obtained 15/15, with no neurological focal signs. Simple radiological studies of the skull showed that the object (a file) was stuck in the base of the skull. Jael syndrome was diagnosed. Left parietooccipital craniectomy was performed around the injury site, dural cross opening with center at the site of the stab entry. The weapon was removed and careful hemostasis was performed. Duroplasty was performed with epicranial tissue and hermetic suture for each plane from depth to skin with May stitches. Treatment with antibiotics, analgesics and anticonvulsants was indicated. Postoperative computerized axial tomography showed post craniectomy bone defect, unaltered brain structures, no remains of metallic material, or displacements of the midline structures. The postoperative evolution was satisfactory; and the patient had medical discharge after 10 days. He maintained anticonvulsant treatment for 6 months. A year later he remains asymptomatic and has joined his work activity.
Conclusions: Good evolution of the patient was achieved by performing a craniectomy around the lesion, dural cross opening, duroplasty with epicranial tissue and hermetic suture for each plane from depth to skin. Similarly, anticonvulsant treatment for 6 months was effective.


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