Penetrating Brain Injury through a Pre-existing Skull Defect: Case Report.

Penetrating brain trauma represents about 0,4% of traumatic brain injuries. In the literature, there is a number of case studies and case-series on non-missile penetrating injuries management, but reports on penetrating brain injuries through a craniectomy are lacking. A 44-year-old male was transferred to the Emergency Room in a comatose state after being stabbed on the head by a sharp object at an area where a previous decompressive craniectomy took place years ago. Computed tomography of the head showed an extensive intracerebral hemorrhage with intraventricular extension and diffuse subarachnoid bleeding. He was immediately transferred to the operating room for hematoma evacuation and hemostasis. Postoperatively, a slight improvement in his neurological status was initially noted, but the patient's clinical course was complicated by a central nervous system infection. Following a long stay and multiple re-operations, he eventually died due to septic shock and multiorgan failure. Non-missile penetrating brain injuries can be life threatening. Prognosis is dismal in those with pre-existing skull defect and severe brain damage despite aggressive medical and surgical treatment.