Article

Sewing Needles in the Brain: Infanticide Attempts or Accidental Insertion?

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Abstract

Placing of sewing needles in the brain through the anterior fontanelle was first described in Germany in 1914. Forty cases have been reported in the scientific literature; most of them were identified in Turkey and Iran, with only a few cases in the Far East, North and Eastern Europe, and the United States. The only case observed in Italy was recorded in 1987. In nonmedical literature, this practice was frequently described in Persian novels, and it has been thought that this ritual could have been diffused with the Persian Empire domination over the centuries. We report on a new Italian case of an 82-year-old woman admitted for progressive right hemiparesis and gait disturbance. Brain computed tomography scan showed a left frontoparietal chronic subdural haematoma and, surprisingly, three 4-cm-long sewing needles inserted through the region of the anterior fontanelle. The patient and her friends and family did not remember any event justifying their presence. Subdural collection was evacuated by craniotomic approach, and the sewing needles were left in place and followed up. The rare cases of intracranial needling reported in the literature may represent only the tip of the iceberg. The phenomenon is usually reported as an incidental finding in asymptomatic adults, whereas many babies could not have been diagnosed because they died. The therapy remains controversial, although many authors suggest only follow-up for asymptomatic patients. In this article, all the pertinent literature is reviewed and the most important clinical aspects are discussed, along with a historical assessment of the problem.

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... Sewing needles are the most unusual foreign bodies that may be found in the brain and may be a homicidal attempt in infancy or early childhood before the closure of the fontanels [40]. ...
... The occurrence of an intracranial needle is an unusual state that mostly occurs in early childhood as a result of insertion from anterior fontanel with the intent of infanticide [40]. Similar cases are reported from China due to the one-child policy but because of the regime, a newer subject has been emphasized enough. ...
... We carried forward literature review from Sturiale et al. [40]. They reported 40 cases from 1914 to 2009. ...
Article
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Background and aim Late-onset seizure due to intracerebral needle is a rare entity. Most of them were clinically asymptomatic and rarely presented with seizure. Sewing needles are used in homicidal attempt in infancy or early childhood before the closure of the fontanels. Because of sociologic, politic, and scientific deficiencies subject remained untouched. We tried shedding some light on this ambiguous phenomenon. Material and methods We report a 54-year-old man who was admitted to our neurosurgery outpatient department with epilepsy due to a sewing needle located in the left frontal lobe of the brain and made extensive literature review. Result Patient’s physical and neurological examinations were completely normal. All biochemical and hematological tests were normal. Cranial tomography demonstrated a linear density at the left frontal lobe compatible with a sewing needle. Patient was followed-up with antiepileptic treatment with no seizure. Sixty cases from up-to-date literature and past cases were reviewed. Patients’ ages differ from 4 days to 70 years. Our review showed four cases treated with antibiotics, 19 patients went to surgery, and others just followed-up with antiepileptic and other drugs. Conclusion Literature needs an autopsy series for a more intimate estimation. Due to psychosocial and legitimacy problems, matter should be handled cautiously and law enforcement agencies must be informed. Follow-up with medication is the first line of treatment with asymptomatic patients. Treatment is dictated by clinic onset, physical examination, and patient consent.
... The most common symptoms are headache and epilepsy [7]. Most of them were identified in Turkey and Iran, with only a few cases in the Far East, North and Eastern Europe, and the United States [9]. Only One case was reported in China in 2001 [10]. ...
... Headache and epilepsy are the main symptoms and they often appear when the patient reaches adulthood [12]. Other rare clinical features of intracranial needles are hemiparesis and gait disturbance, brain abscess, hemi-chorea and cranial nerve palsy [9,17,18]. However, to date, no case presenting with absence seizure has been described. ...
... According to the majority of authors, the therapy of choice should consist of follow-up alone when no clinical signs or symptoms are present. Antiepileptic drugs should be reserved only for patients with seizures [9]. Amirjamshidi et al. [7] described that there was no absolute indication for removing intracranial sewing needles detected in the later decades of life. ...
Article
Objective To investigate therapeutic effect of surgery that removes an intracranial foreign body through the intracranial sagittal sinus with help of intraoperative navigation and intraoperative fluorescein angiography. Methods We performed operation on a patient with intracranial foreign body. Under guidance of intraoperative navigation, combined with intraoperative fluorescein angiography to avoid sagittal sinus damage, we opened the dura mater and removed the foreign body with minimally invasive technique. ResultsSurgical positioning was very accurate with neuronavigation, intraoperative fluorescein angiography displayed the venous drainage along the sagittal sinus in order to prevent its rupture; the intracranial foreign body was removed successfully without any post-operative complications. Conclusion Intraoperative navigation and intraoperative fluorescein angiography technologies to guide the removal of the foreign metal body inserted through the sagittal sinus have the following advantages: Accurate positioning, minimally invasive, reliable curative effect, quick postoperative recovery and overall fewer complications.
... Embedding sewing needle(s) into brain through natural openings and soft parts of the cranium has been reported for infanticide purpose (1). The relative small number of reported cases in medical literature does not match the real number of cases due to missed-detections, lack of physician referral or infant death before disclosure of respective cause (1,2). ...
... Embedding sewing needle(s) into brain through natural openings and soft parts of the cranium has been reported for infanticide purpose (1). The relative small number of reported cases in medical literature does not match the real number of cases due to missed-detections, lack of physician referral or infant death before disclosure of respective cause (1,2). ...
... The usual approaches to such patients have ranged from follow-up observations to surgical interventions with a variety of outcomes (1,5). ...
... Patients, who presented with seizure due to intracranial needles, were rarely reported previously. [3][4][5][6][7] We report a 14-year-old boy with epilepsy resulting from the presence of sewing needle located in the brain. ...
... There are reports of sewing needles and other foreign objects retained in the brain for long periods of time without any symptoms. Since its first description in 1914, approximately forty cases have been reported all over the world, which were reviewed by Struiale et al. 5,8 In this review, about one third of patients with intracranial needles were asymptomatic and had been discovered incidentally. The most seen complaint was long time history of slight headache and secondly was seizure. ...
... Initial complaints such as fever, hemiparesis, extrapyramidal signs, cranial nerve palsy, hemi-chorea, brain abscess, nausea, vomiting, lethargy, hemorrhage, meningitis and rarely hypothalamic syndrome had also been reported in this review. 5 None of these symptoms were detected in our patient except seizure. ...
Article
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Placing of sewing needles in the brain through the anterior fontanel is a rare entity. There are very few cases reported in literature. Most of them were asymptomatic, but some of them presented with seizure. We report here a 14-year-old boy, who was admitted to the Pediatric Neurology Department with a history of generalized tonic-clonic seizures due to sewing needle located in the frontal lobe.
... One case was reported in Italy in 1987. 4 Intracranial needles can present later in life with features of headache, seizures or altered behavior. 5 We report a fifty-two-year old woman with status epilepticus (SE) resulting from the presence of sewing needle situated in the brain. ...
... Other rare clinical features of intracranial needles are hemiparesis and gait disturbance, brain abscess, hemi-chroea and cranial nerve palsy. 4,10,11 It is a common feature in these cases is that patients and their relatives claim to have no idea about how the needles was inserted. Similarly, in our case, the patient and her relatives claimed not to know how the needle got into her head. ...
... Antiepileptic drugs should be reserved only for patients with seizures. 4 Amirjamshidi et al. 3 described that there was no absolute indication for removing intracranial sewing needles detected in the later decades of life. In keeping with this, we have decided to follow-up the patient and continue antiepileptic treatment. ...
Article
Intracranial needles are a rare entity. They most commonly present with headache and seizures. The management of such patients is sometimes challenging. We present a 52-year-old woman who was admitted to our hospital with status epilepticus, because of an inracranial needle. There was no history of epileptic seizures and she was asymptomatic until the time of presentation.
... The insertion of a foreign body into the intracranial compartment most commonly occurs as a result of high velocity injuries involving firearms and other trigger operated devices such as spear and nail guns [1]. A less common but well documented intracranial foreign body finding is that of sewing needles that have been inserted through the anterior fontanelle in what is believed to be a failed attempt at infanticide [2][3][4]. ...
... Leaving the needles in situ poses a number of risks, including potential future seizures [4][5][6], headaches [7], infection [8] and migration of the needles and subsequent neurological injury [9]. However, surgery exposes an individual to operative complications. ...
Article
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Self-insertion of foreign bodies is a rare event. This report details a 56-year-old male who had self-inserted six hypodermic needles into his left frontal lobe 6 years previously. He subsequently presented with seizures and went on to have the needles surgically removed. This represents the first case of its type involving hypodermic needles. Given that intracranial needles are a rare finding, the management of such patients is complex. Two management issues in particular that require consideration are: (i) can the needles be left in situ and (ii) does removal of the needles reduce the risk of seizures in the long term? Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015.
... Several studies in the literature have reported craniotomy as the surgical procedure in 8 out of 13 patients [4,33,34,[41][42][43][44]. In some rare cases where foreign bodies are incidentally discovered, conservative management may be considered [45]. However, leaving foreign bodies in situ entails several risks, including headaches [46], infections [47], seizures [48][49][50], and migration of foreign bodies with subsequent neurological damage [51]. ...
Article
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Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. Computed tomography each time revealed the presence of a metal foreign body (screw, nail, metal rod, and wire) passing through the frontal bone into the frontal lobe. In each situation, the foreign body was safely extracted with a favorable outcome. Despite the use of the latest imaging modalities, metal artifacts can limit the assessment of vascular involvement, and special attention must be given to preoperative planning. Surgical extraction of the foreign body can be safely performed when appropriate preoperative planning is carried out to consider all possible complications.
... 5 Transcranial sewing needle penetration through the fontanelle sometimes occurs as a homicide attempt (often related to cultural background). [5][6][7][8] Until 2010, 40 case reports were published about suspected sewing needle insertion through the fontanelle. 6 Most of them were clinically asymptomatic and rarely presented with seizure, headache or altered behaviour. ...
Article
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An 8-year-old Maltese dog was referred for surgery due to an intracranial foreign body. The dog had been hit by a car and had experienced three generalised tonic-clonic seizures. Examination by computed tomography revealed an intracranial metallic object oriented in a vertical direction. The ventral end protruded by 2 mm, in close proximity to the temporomandibular joint. Furthermore, moderate bilateral ventricular dilatation was observed. During the surgery, object removal was initially attempted via the oral cavity , but due to deep coverage by the neighbouring tissues, a rostrotentorial craniotomy was subsequently chosen to remove the foreign body from the brain. The foreign body was identified as a sewing needle. Postoperative computed tomography revealed that the intracranial part of the needle had been removed completely, leaving only the extracranial part, which had become detached from the rest of the needle. Antiepileptic drugs have been continued postoperatively, and the dog is currently symptom-free.
... In this case study, the moving ingested needles were traced and localized using x-ray before development of serious complications, followed by successful surgery. Sharp and elongated foreign objects, such as pins, sticks, grass awns or sewing needles are more prone to migration as their shape makes penetration through soft tissues and causes life-threatening complications (Cottam and Gannon, 2015), even it may migrate up to the liver (Bulakci et al., 2011), pericardium (Fennessy et al., 2009), mediastinum (Ferro et al., 2008), cervical spine (Silvestro et al., 2001), lung (Ozkan et al., 2011), right ventricle (Sarmento-Leite et al., 2000 and, most commonly, the brain (Pelin andKaner, 2012 andSturiale et al., 2010). ...
Article
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An unusual case of 4-years old female cat was presented to the Teaching and Training Pet Hospital and Research Center (TTPHRC), Purbachal, Dhaka with a complaint of accidental ingestion of sewing needle connected with long thread on the day of incidence. The presented cat didn't have any other complication on physical examination. Lateral and ventrodorsal radiograph of the abdomen showed the location of sewing needle in the stomach. On the 2 nd day of incidence, presurgical radiographs confirmed the migration of sewing needle to the posterior location. Following laparotomy, stomach and intestine were gently checked by manual palpation for any perforation and location of sewing needle detected in the duodenum. The needle was successfully extracted by duodenotomy. The owner was contacted regularly till two weeks post-operatively and the cat recovered without any complication., 2020. Duodenotomy in a cat for removal of a sewing needle: A case report. Bangladesh Journal of Veterinary and Animal Sciences (BJVAS), 8(1):151-154.
... In one case, sewing needle penetration that occurred during childhood led to the formation of a fistula between the jejunum and aorta in a young adult man. This type of migration may complicate the identification of the foreign body during surgery [6][7][8] Lukefahr Major risk factors for abuse include a young age of the mother, low educational level, young age during pregnancy and delayed prenatal care [9][10][11][12] . Among needles, disposable needle syringes are most common type of needle used for injection of intravenous drugs, and may be re-used up to 20 times. ...
... According to the position of the needle, we concluded that this must be the result of unsuccessful crime. Until now, the oldest age at symptoms first present is 82 [9], reveals a question that how did the brain tolerated those sewing needles in such a long period without any symptoms. Azariah et al. showed that the brain tissue tolerates metallic foreign bodies very well, and the incidence of delayed brain abscess is relatively rare [10]. ...
Article
Intracranial foreign bodies are rare entities, sewing needles are even more so. There are very few cases reported in scientific literature. Most of the patients presented with headache or seizure, but some of them were asymptomatic. We detail a 61 year old man who was admitted to our hospital with slight dizzy and accidently found a sewing needle in his brain. Fortunately, he suffered no headache or epileptic seizure and was asymptomatic during the past years.
... Placing sewing needles in the brain through the anterior fontanelle was first reported in Germany in 1914 (7). Penetrating objects are a common cause of intracranial injury. ...
Article
Full-text available
Introduction Intracranial needles are rare entities. Intracranial foreign bodies due to non-missile intracranial penetrations are one of the most rarely encountered situations in neurosurgery. Sewing needles are among the more unusual foreign bodies that may be found in the brain. Although uncommon, foreign body cases are important and interesting. Foreign bodies enter the body through trauma or iatrogenic injuries. Needles are mostly inserted through fontanelles, cranial sutures, and more rarely through the orbits in infancy for the purpose of killing unwanted babies. Case Presentation This article presents a case of intracranial foreign body found upon radiography. A 24-year-old female, who two days prior to presentation suffered only once from dizziness, and was otherwise healthy. Conclusions Because this incident may have occurred during the patient’s neonatal period, it may be a case of child abuse. In spite of the very limited number of cases in the literature, having a stepmother, a stepfather, or a babysitter, being the youngest child, or having family members who suffer from psychiatric disorders, (especially if these relatives are responsible for child care), living in a society that allows homicide of children born from extramarital relationships, and being female have been suggested as possible risk factors.
... Sewing needle foreign bodies in the human medical literature have been reported as migrating foreign bodies found in the liver, 3,4 pericardium, 5 mediastinum, 6 cervical spine, 7 lung, 8 appendix, 9 right ventricle 10 and, most commonly, the brain. [11][12][13][14][15][16] Most of the non-brain cases are presumed to be secondary to ingestion, accidental in some cases, intentional in others. The majority of cases of intracranial sewing needle foreign bodies are believed to be failed attempts at infanticide from needles inserted prior to closure of the fontanelles. ...
Article
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Case summary A 1-year-old, female spayed domestic shorthair cat with a 6 week history of upper respiratory signs and a progressive reluctance to move, which culminated in a right-sided hemiparesis, was found to have a sewing needle foreign body lodged in the brainstem. Surgical extraction of the needle was successful and the cat’s neurological deficits resolved over the days to weeks following its removal. Relevance and novel information This case report describes, to our knowledge, the first reported incidence and management of an ingested sewing needle migrating into the central nervous system of a cat.
... Incidental findings have been linked with needle insertion through the fontanelle or the sutures during infanthood and associated with homicide attempts. Complications of intracranial foreign bodies include seizure, headache, intracranial bleeding and infection, and related focal neurological signs [5][6][7][8]10]. In our case, the needle localization suggested the penetration through the anterior fontanelle before closure. ...
Article
Full-text available
A 4-year-old boy with normal physical and mental development presented to the emergency room with minor head injury and skin laceration on the right frontal region following an accidental fall in a ditch while playing with other kids. At presentation, he had normal neurologic examination. The skull X-ray showed a 4.5 cm long sewing needle-like foreign body, which was later confirmed by cranial computed tomography scanning. There was no suspected entry at the corresponding location to suggest an acute penetrating injury. This object may have penetrated during early infanthood before closure of anterior fontanelle. A nonsurgical management was opted because there were no neurological complaints, even after a three-year follow-up.
... Some authors have suggested that the biochemical composition of the iron rust surrounding the sewing needles in the brain may be a cause of headache. 13 There is no consensus on whether the retained needles should be removed surgically or not, and this issue has been the subject of controversy in other reports. 5,6 Surgical interventions were reported in medulla oblongata lesions by needles in several cases. ...
Article
Full-text available
We report the case of a 22-year old man with intracranial metallic foreign bodies who presented complaining of a headache. His history of headaches had begun when he was five years old and continued with increasing severity. Six months before hospital admission, nausea and vomiting began to accompany his headache. Computed tomography scan revealed that 2 metallic foreign bodies were located adjacent to the vertex and another was next to the ambient cistern. The location and position of foreign bodies suggested that they were introduced in infancy through the anterior fontanelle before its closure in an unsuccessful homicide attempt. This case is one of the few reported cases combining headache and intracranial foreign bodies and we discuss the relationship between headache and these metallic materials.
Article
This case report delves into a unique occurrence of MRI-induced headaches attributed to an unsuspected intracranial foreign body. A male patient, presenting persistent headaches, experienced exacerbation of pain upon entering the MRI suite, hindering the imaging procedure. A subsequent head CT scan revealed a nail within the cranial cavity, stemming from a previous nail gun injury. Surgical removal was deemed unsafe, leading to continued observation. This case emphasizes the need for cautious exploration of abnormal symptoms in the MRI suite, urging healthcare professionals to consider potential foreign bodies. The incident underscores the risk of metallic fragments causing complications during MRI procedures and highlights the importance of thorough patient assessment before resorting to MRI imaging.
Article
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During compulsory examination of 25 years old soldier in psychiatric clinic, as psychopathy features were observed in him, intracranial foreign metal body sewing needle was found out. The patient and his parents had no any information about existence of intracranial sewing needle till the examination. Parents of the patient could not give any anamnestic information to the doctor in charge on existence of sewing needle in intracranial region. It is clear that sewing needle can be entered into intracranial region only till the period sinciput became firm. The fact that sharp point of the needle is towards down shows once again that the needle was pricked intentionally. In the result of the research the conclusion was reached that as the patient was the only grandson in the family, near relatives enviously entered sewing needle into his intracranial region from the sinciput while he was baby in order to murder him. The accident was evaluated as the result of unsuccessful crime. So, in the result of the research we can come to the conclusion that instrumental examinations (roentgenography of skull in two projections, computer tomography, nuclear magnetic resonance examination, etc.) for psychiatric patients are necessary.
Article
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The author presents a 48-year-old man who showed an intracranial sewing needle incidentally detected on a skull radiograph. He had no history of cranial surgery or a penetrating head injury. On radiography, the sewing needle was found to be located close to the frontal bone in the midline, with a trajectory to the right anterior skull base. Computed tomography angiography revealed that the needle head was located at an approximately 3.57 mm depth from the inner table and attached to the cortical vein. The distal end of the needle was surrounded by the right distal pericallosal artery. No cortical injury or vascular injury was observed. The needle may have penetrated during the early period before the closure of the anterior fontanelle.
Article
An intracranial metallic foreign body (sewing needle) was diagnosed in an 11-month-old Cavalier King Charles Spaniel. Clinical evaluation showed drooling and chewing, but an otherwise normal neurological examination. Skull radiographs showed a metallic foreign body extending from the pharynx into the skull. A CT scan confirmed the presence of a foreign body crossing the right foramen lacerum into the brain. The needle was removed surgically with the aid of fluoroscopy. No complications were noted, except for transient right Horner's syndrome, most likely due to partial damage of the sympathetic postganglionic fibres that lie in the region of the tympanic bulla following surgery. The owner reported the dog being healthy 3 months after surgery.
Article
Patients with intracranial needles have rarely been reported. Several foreign bodies penetrating the cranium such as knives, nails, pencils, and wood pieces have been described in the literature. It is rare to discover a foreign body which has been inserted through either of the fontanelles before their closure in an attempted infanticide. Here we report one such rare case of intracranial sewing needle in a 24-year-old female which was accidentally inserted through the open anterior fontanelle from the traditional skull cap she was wearing during infancy. The needle was discovered incidentally on a routine skull radiograph done for a minor head injury. It was decided against any intervention to remove the needle owing to the fact that the presence of the foreign object was not causing any symptoms.
Article
The objective of this clinical case study is to describe the first clinical case of an intracranial sewing needle identified in veterinary medicine and to describe the second case of intracranial foreign body secondary to pharyngeal perforation. A one-year-old Maltese dog with acute haemorrhagical vomiting and seizure was evaluated. A cerebral CT scan revealed the presence of a sewing needle inserted into the nasopharynx, which perforated the caudal cranial fossa through the brainstem, cerebellum and caudal part of the forebrain. An emergency surgery was performed, the needle was removed and the dog recovered well during the following 72 hours. One month after the surgery, the dog was still fine. This clinical case reinforces the possibility of cranial perforation after sharp foreign body ingestion. Intracranial foreign body should be part of the differential diagnosis in dogs when acute digestive signs are associated with acute neurological complications.
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Craniospinal penetrating foreign body (FB) injuries are interesting, but rarely observed, cases. They are important in terms of the complications that they may cause. The etiologies of craniospinal penetrating injuries and intracranial FB are also different. Though a sewing needle is more rarely seen in an intracranial FB, it may occur as atttempted infanticide or as a result of an accident especially in early childhood before the closure of fontanels. We detected an intracranial sewing needle in the head radiograph of a case admitted to the emergency department for another reason. We present this case since this is a rare injury and the etiologies of craniospinal penetrating foreign body have different characteristics.
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Accidents and injuries associated with foreign bodies are important causes of childhood mortality. Diagnosis can be facilitated by obtaining a detailed history, performing a physical examination and utilising simple imaging methods. We report a case involving a fragmented sewing needle in the left leg of an 8-month-old male infant. He was admitted to our clinic with diffuse pain in the left leg, limitation of leg movements and an inability to stand. The patient was successfully treated with open surgery under fluoroscopy. Soft tissue foreign bodies and potential child physical abuse should be considered in children with ambiguous symptoms and unusual skin lesions. Parents should be educated on prevention of household accidents involving children. Penetration of sewing needles into the body has been rarely reported in the literature. We thus report this case to draw attention to the complications and morbidity associated with a delayed diagnosis in such cases.
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A 37-year-old patient is reported with intracranial sewing needles, which were located in the right frontal lobe. Both clinical and radiological findings suggested that these needles must have been introduced in infancy before the closure of anterior fontanelle during an unsuccessful homicide. Usually intracranial foreign objects are placed due to penetrating trauma or surgical procedures. Child abuse has been known for centuries. Many types of physical traumas have been reported, especially in Western countries. In Iran, insertion of sewing needles into the brain aiming to kill the infant have been seen in a lot of cases. This situation takes part in a lot of Persian stories. We reported a 37-year-old man who had 2 intracranial sewing needles with unknown etiology.
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Background and objectivesChild abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.
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A penetrating injury with a sewing needle is a rare phenomenon. The pathophysiological mechanism of late epilepsy after penetrating injuries is not clear. A 10-year-old female child had a seizure. An X-ray study of the skull and the cranial computed tomography scans showed a foreign object retained in the skull cavity. She was intact on neurological examination. Electroencephalogram (EEG) showed that there was bioelectrical disorganization in both hemispheres, being more prominent on the left side. A right posterior frontal median craniotomy was performed in order not to retract the left hemisphere within the interhemispheric fissure and the sewing needle was removed successfully. The sewing needle was rusted. The reason for the patient's seizure, 10 years after the injury, may be the corrosion of the sewing needle and rust formation in this case.
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A 9-year-old male patient complaining of seizure attack was admitted to the neurosurgery department. Radiologic investigations revealed a 5-cm-long metallic sewing needle extending from the right frontal cortex to the right lateral ventricle. Burr hole surgery was performed and the needle was grasped with biopsy forceps and removed with endoscopic guidance. The patient recovered without any complications.
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There are 44 million missing women in India. Gender bias; neglect of girls, infanticides and feticides are responsible. The sex ratio at birth can be used to examine the influence of antenatal sex selection on the sex ratio. Records from 321,991 deliveries at one hospital over 11 decades were utilized. The middle year in each decade was taken as representative of the decade. Data from 33,524 deliveries were then analyzed. Data for each decade was combined with that of previous decades and compared to the data of subsequent decades to look for any change in the trend. Sex ratio in the second children against sex of the first child was studied separately. The mean sex ratio for the 110 years examined was 910 girls to 1000 boys (95% CI; 891 to 930). The sex ratio dropped significantly from 935 (CI: 905 to 967) before 1979, to 892 (CI: 868 to 918) after 1980 (P = 0.04). The sex ratio in the second child was significantly lower if the first child was a girl [716 (CI: 672 to 762] (P<0.001). On the other hand, there was an excess of girls born to mothers whose first child was boy [1140 girls per 1000 boys (CI: 1072 to 1212 P<0.001)]. The sex ratio fell significantly after 1980 when ultra sound machines for antenatal sex determination became available. The sex ratio in second children if the first was a girl was even lower. Sex selective abortions after antenatal sex determination are thus implicated. However data on second children especially the excess of girls born to mothers who have a previous boy seen in the decade before the advent of antenatal ultra sound machines, suggests that other means of sex selection are also used.
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Yesterdays they changed my room. Am I completely cured now? Will I be free to leave next week as the superintendent promised? Have I been sick at all? For one year, they wouldn't give me a pen and paper which I wanted more than anything else. I always thought about the many things I would write once they gave me a pen and paper. Yesterday, without asking, they brought me paper and a pen...something I longed for so much...something I waited for so long. But what's the use? Since yesterday, I have been able to write nothing, no matter how hard I try. It's as though someone were holding me back, as though my arm were paralysed. Now, as I read over the garbled lines which are etched into the paper, the only words I can make out are... “three drops of blood.”
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Brain foreign bodies and penetrating missile injuries of the brain are familiar topics for Iranian physicians, especially after Iran and Iraq war. But it's not easily plausible that there is a couple of sewing needles in the cranium of a patient who has not any history of head trauma or penetrating injury. The patient was a 42-year-old man who admitted in neurology ward of Mottahari Hospital in Urmia city with a complaint of headache. Brain computed tomography revealed some hyperdense foci with artifact shadows adjacent to them in frontoparietal region of the brain. Skull plain radiography indicated two sewing nee- dles in his cranium. Probably these needles were inserted in cranial fossa at infancy when the fontanels were steel patent. Iran J Med Sci 2007; 32(4): 254-255.
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✓ The insertion of sewing needles through the fontanels of an unwanted baby is apparently an ancient practice of which there are still instances. In this paper two such cases are described, one a man of 32 and the other a woman aged 31 with needles in a vertical position near the midline of the convexity of the brain. The first patient had had epileptic attacks for 8 years, and the other headache and hemiparesis for 7 months. Removal of the needles resulted in amelioration of the symptoms. The needles obviously had been introduced when the anterior fontanels were still open. The long interval before the onset of symptoms has been observed in the two other cases reported in the literature.
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The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq-Iran war (1980-1988). In this retrospective study, the authors evaluated 189 patients who sustained penetrating head injury and suffered posttraumatic epilepsy during the Iraq-Iran war (mean 18.6 +/- 4.7 years after injury). The probabilities of persistent seizures (seizure occurrence in the past 2 years) in different periods after injury were estimated using the Kaplan-Meier method. The possible prognostic factors (patients and injury characteristics, clinical findings, and seizure characteristics) were studied using log-rank and Cox regression analysis. The probability of persistent seizures was 86.4% after 16 years and 74.7% after 21 years. In patients with < 3 pieces of shrapnel or no sphincter disturbances during seizure attacks, the probability of being seizure free after these 16 and 21 years was significantly higher. Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.
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Three new cases of intracranial sewing needles are reported and are reviewed with 10 other published cases. These needles must have been introduced in infancy before the closure of fontanelles. The intention, at least in most cases, has been infanticide. Except in one case which the mother reported and two cases found at necropsy, the others were diagnosed by skull radiography. Headache and epilepsy were the main symptoms and they often appeared when the patient had reached adulthood. Removal of the needles lessened the symptoms.
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A child suffered a sixth and seventh cranial nerve palsy due to intracerebral insertion of a stylet. The stylet was introduced through the anterior fontanel, most probably in an attempt at infanticide. The migration of the stylet through the brain was monitored because the child was first examined 6 years earlier. At operation the cranial part of the stylet lay in the fourth ventricle, compressing the facial nerve as well as the nucleus of the abducens nerve. The lower part of the stylet had reached the C-5 level.
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A 20-year-old patient is reported with three intracranial sewing needles, which were located in the frontal lobes. The clinicoradiologic findings strongly suggested that they must have been placed into the brain through the anterior fontanelle during an unsuccessful homicide attempt in infancy.
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Two sewing needles were found in a woman's cranial cavity by X-ray examination after she had sustained traffic injury. After investigation and analysis, it has been confirmed that the sewing needles were inserted by others when she was an infant, and not by the traffic injury.
Article
Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.
Article
We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications.
Article
A 45-year-old patient was found to have an intracranial sewing needle, located in the left frontal lobe. The needle was detected incidentally after minor head trauma. The clinical and radiological findings suggested that it might have entered the brain through the anterior fontanelle.
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