Penetrating cranial trauma following an assault by knife remains a very serious pathology which can be fatal for the patient.
Surgical management must be done as quickly as possible. CT scan remains essential, an angiography may sometimes be necessary
before the surgical procedure. Presenting by this observation, the case of a 28 year old patient, victim of a knife attack, operated at
the Hassan II university hospital of Fez-Morocco.
Mr Y.B, 28 years of ages, with no significant priors; was admitted
to the emergency room at the Hassan II university hospital,
for a cranial trauma following an assault by knife. The clinical
assessment of the patient at his admission showed a conscious
patient with a Glasgow score of 15, with no sensitive or motor
deficit, hemodynamically stable with a normal respiratory function.
The examination of the 12 pairs of cranial nerves showed a bilateral
blindness with an amaurotic mydriasis. The local physical exam
found a knife lodged in the right side of the occipital region (Figure
Figure 1: Penetrating cranial trauma following an assault by knife.
Figure 2: Skin incision and musculocutaneous dissection.
Figure 3: Right occipital bone flap.
The patient underwent a Cerbral CT Scan IV, which was
completed with an angiography scan, both found no vascular lesion.
The patient was rushed to the operating room where he underwent
an extraction of the foreign object using a bone flap (Figure 4-6).
The postoperative follow-ups were marked by the occurrence of a
status epilepticus, which led the patient to remain, intubated and
sedated in the ICU for 5 days, with a daily Trans cranial Doppler
ultrasound that came back satisfactory. After extubation, the patient
recovered his conscious state and his vision.