Good clinical practice in dubious head trauma – the problem of retained intracranial foreign bodies

OBJECTIVE: In young people, traumatic head and brain injuries are the leading cause of morbidity and mortality. In some cases, no neurological deficits are present, even after penetrating trauma. These patients have a greater risk of suffering from secondary injuries due to secondary infections, brain edema, and hematomas. We present a case report which illustrates that brain injuries that do not induce neurological deficits can still result in a fatal clinical course and death, with medicolegal consequences. CLINICAL PRESENTATION: A 19-year-old patient was admitted to hospital suffering from a head injury due to an assault. He reported that he was attacked from behind. Medical examination showed no neurological deficits, and only a small occipital wound. Neuroimaging of the cranium revealed that a knife blade was penetrating the cranial bone and touching the superior sagittal sinus. INTERVENTION: After removing the foreign body, magnetic resonance imaging showed that the superior sagittal sinus remained open. CONCLUSION: We want to stress that possible problems can arise due to the retention of objects in the cranium, while also highlighting the risk of superficial clinical examination.