Delayed headache 11 years after a pub fight: an unusual spontaneous intracerebral hemorrhage succeeding a temporal glass shard injury. Illustrative case

BACKGROUND: Intracerebral hemorrhage (ICH) in young patients is rare and often associated with vascular malformations, drug abuse, or genetic conditions. Early diagnosis and treatment are critical because of the potential risk of rebleeding and long-term consequences. This case report presents an unusual correlation between a prior traumatic incident and the manifestation of an atypical ICH 11 years later. OBSERVATIONS: A 37-year-old male presented with retroorbital headaches, confusion, and seizures. Imaging revealed an atypical ICH in the left middle temporal gyrus, accompanied by retained glass shards in the adjacent temporal muscle and bone. Angiography ruled out vascular malformations but suggested an eroded middle cerebral artery branch underneath an osseous defect potentially caused by a bone-transgressing glass shard. Surgical exploration confirmed the vessel as the source of the ICH and was followed by an uneventful hematoma removal and postoperative course. LESSONS: This case underscores the significance of recognizing delayed complications resulting from retained foreign bodies (FBs). Complete removal of extracranial FBs is imperative to prevent further harm. Clinicians should maintain an awareness of the potential long-term consequences and complications associated with FBs, utilizing comprehensive diagnostics to detect and localize FBs. Timely intervention such as resection or planned follow-up is essential for effective management and mitigation of adverse outcomes.