Visual diagnosis in emergency medicine
Medullar Injury Caused by Sewing Needle Puncture

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Introduction

A number of injuries to the central nervous system caused by needles have been described, but injuries to the brain stem after needle penetration are very uncommon (1, 2, 3, 4, 5, 6, 7). Therefore, we report the case of a patient who had a lesion in the medulla oblongata caused by a sewing needle that had migrated through the foramen magnum; she had a good outcome after surgical extraction.

Section snippets

Case Report

A 23-year-old woman presented to the Emergency Department for treatment of a self-puncture wound to the posterior cervical area caused by a sewing needle (suicide attempt). The patient had a medical history of schizophrenia. On admission, the patient's Glasgow Coma Scale score was 15. The blood pressure was 90/50 mm Hg, heart rate 74 beats/min, and respiratory rate 28 breaths/min. Physical findings included facial erythema, general hyperhydrosis, nausea, and vomiting. Neurological examination

Discussion

Most penetrating needle injuries result in damage to the brain. Penetrating needle injury of the central nervous system has been reported after migration of acupuncture needles into the spinal nerve, as well as in cases of child abuse (2, 8). In children, the most common route of needle penetration is through the anterior fontanel or orbit (3, 4). Injuries to the medulla after needle penetration are rare; there have been only two such case reports published previously (6, 7). Generally,

Conclusion

We have reported a rare case of injury to the medulla caused by needle penetration. An improvement in the neurological findings was obtained after careful surgical removal of the needle and appropriate antibiotic treatment. The patient's post-surgical course was unremarkable without any infectious complications.

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