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Case Report
Visual Disturbance Caused by a Nail Gun-Induced Penetrating Brain Injury
Jin Bong Ye, Young Hoon Sul, Se Heon Kim, Jin Young Lee, Jin Suk Lee, Hong Rye Kim, Soo Young Yoon, Jung Hee Choi
J Trauma Inj. 2021;34(3):203-207.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0030
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AbstractAbstract PDF

Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.

Summary
Original Article
Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department
Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon
J Trauma Inj. 2013;26(3):104-110.
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AbstractAbstract PDF
PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.
Summary

J Trauma Inj : Journal of Trauma and Injury