Intracranial Metallic Foreign Bodies in A Man With A Headache

Neurology International 2012; volume 4:e18
Intracranial metallic foreign Case Report Correspondence: Tuncay Kaner, Istanbul

bodies in a man with a headache Medeniyet University School of Medicine,
A 22-year old man, who was employed as a Department of Neurosurgery, Istanbul, Turkey.
Zerrin Pelin,1 Tuncay Kaner2 construction worker, presented with a history Tel. +90.532.2627715.
1Erenköy of chronic headaches. He was from a small vil- E-mail: tuncaykaner@gmail.com
Psychiatry and Neurology,
Education and Research Hospital, lage in eastern Turkey and he is the third of 8
Key words: brain, foreign body, sewing needle,
Department of Neurology, Istanbul; children. His headaches had begun when he
homicide, headache.
2Istanbul Medeniyet University School was five years old. During his childhood, dif-
of Medicine, Department fuse pain involving posterior aspects of the Conflict of interests: the authors report no poten-
head and periorbital area occurred regularly, tial conflict of interests.
of Neurosurgery, Istanbul, Turkey
especially when he was concentrating on
something in particular. He denied any hospi- Received for publication: 29 July 2012.
talizations during childhood due to his fami- Revision received: 23 August 2012.
ly’s poor socio-economic status. When he was Accepted for publication: 2 October 2012.
Abstract 20 years old, the frequency and intensity of
This work is licensed under a Creative Commons
his headaches began to increase. The Attribution NonCommercial 3.0 License (CC BY-
We report the case of a 22-year old man with headache recurred every day and lasted for NC 3.0).
intracranial metallic foreign bodies who pre- more than four hours. During episodes of
sented complaining of a headache. His history headache, the most uncomfortable area was ©Copyright Z. Pelin and T. Kaner, 2012
of headaches had begun when he was five the periorbital areas. Although non-steroidal Licensee PAGEPress, Italy
anti-inflammatory drugs, such as naproxen Neurology International 2012; 4:e18
years old and continued with increasing sever-
doi:10.4081/ni.2012.e18
ity. Six months before hospital admission, nau- sodium, diclofenac sodium and ibuprofen,
sea and vomiting began to accompany his were given to the patient, they did not supply
headache. Computed tomography scan permanent analgesia. Six months before
revealed that 2 metallic foreign bodies were admission to our clinic, his headache took on between intracranial needles and headaches.
located adjacent to the vertex and another was a pulsating quality accompanied with nausea There are previously reported cases of sewing
next to the ambient cistern. The location and and vomiting. needles and other foreign objects retained in
position of foreign bodies suggested that they On admission, his general physical status was the brain for long periods of time without any
were introduced in infancy through the anteri- found to be normal. He was conscious, alert symptoms. In our case, the intracranial nee-
or fontanelle before its closure in an unsuc- and cooperative. He did not have any physical dles were detected after a long period of time.
cessful homicide attempt. This case is one of signs of injury. The patient had no evidence of During that period, the intensity, duration
the few reported cases combining headache intellectual problems, delayed growth or men- and localization of the headache altered as did
and intracranial foreign bodies and we discuss tal retardation. Neurological examination did the accompanying symptoms. All other report-
not show any abnormalities. ed cases except one describe single intracra-
the relationship between headache and these
Cranial radiography detected what appeared nial metallic objects. The radiological findings
metallic materials.
to be foreign bodies adjacent to the vertex in our patients strongly suggest that three
region (Figure 1). Three dimensional cranial needles had been introduced into the brain.
computed tomography (CT) was performed to A variety of penetrating objects of the skull
further evaluate the presence of the foreign and brain have been reported, including
Introduction objects in the cranium. A CT scan showed 2 blades, nails, pencils, splinters of wood and
metallic foreign bodies adjacent to the vertex wire.4 Intracranial foreign bodies are usually
Intracranial foreign bodies are generally due to and one adjacent to the ambient cistern due to penetrating injuries through the cra-
penetrating injuries through the orbit, ear or (Figures 2 and 3). nial bones, orbits and ear.1-3 Intracranial
cranial bones.1-3 Penetrating trauma second- The patient and his relatives stated that they sewing needles have been previously reported
ary to gunshot wounds are a common cause of did not know how these metallic bodies had in the literature.5-9 It has also been reported
injury. However, penetrating cranio-cerebral been introduced. The positions of the foreign that surgical objects may be left in the brain
injuries due to objects such as needles, iron bodies, however, suggested that they were during surgery.10 The radiological findings in
rods, pieces of wood or nails are rare.4 probably inserted through the anterior our patient demonstrated that intracranial
It is rare to discover a foreign body which has fontanelle when the patient was an infant. foreign bodies resembled sewing needles. The
been inserted through either of the Surgical intervention was considered unnec- locations of these objects suggested that
fontanelles before their closure in an attempt- essary and potentially hazardous to the intracranial needles might have been inserted
ed infanticide.5-7 Such foreign bodies are usu- patient, and the metallic foreign bodies in his through the cranium during infancy before
ally detected accidentally, most often after cranium were accepted as an incidental find- the closure of the fontanelle. The intracranial
minor head injury necessitating plain cranial ing. He was discharged from the hospital with location of the sewing needles are thought to
radiography.6 There are only a few patients in analgesic medications and was informed be the result of an unsuccessful infanticide
the literature who present with headache or about the contraindications for magnetic res- attempt or of an accident during infancy.7,11
seizures who have intracranial foreign bod- onance imaging. Amirjamshidi et al. suggested that this is a
ies. In this case, we report a patient with 3 kind of so called battered child syndrome phe-
intracranial metallic foreign bodies who suf- nomenon which might have been traditional
fered from headaches. and prevalent in some communities.12 This
Discussion kind of accident might also have been due to
another child poking a baby with a couple of
We report a case of a possible association needles, or the child could have done it him-
[Neurology International 2012; 4:e18] [page 85]

Case Report
self, and can not remember the event as an gunshot wounds to the head. Analysis of
adult. 12 cases. AJR 1992;15:365-8.
In clinical practice, many physicians prefer 2. Kuroiwa T, Tanabe H, Ogawa D, Ohta T.
magnetic resonance imaging (MRI) to evalu- Chopstich penetration of the posterior
ate intractable headache. It might be possible cranial fossa: case report. Surg Neurol
to see cases like that of our patient especially 1995;43:68-9.
in developing countries and MRI could have 3. Sener RN. Intracranial sewing needles in
disastrous consequences. Therefore, it a 20-year-old patient. J Neuroradiol
becomes more important to make a gradual 1997;24:212-4.
evaluation of pain step by step and an MRI 4. Ashkenazi E, Mualem N, Umansky F.
should not be ordered immediately. The prob- Successful removal of an intracranial
lem of headache in similar cases is not usual- needle by an ophthalmologic magnet:
ly clear. Some authors have suggested case report. J Trauma 1990;30:114-5.
that the biochemical composition of the iron 5. Barlas O, Gökay H. Sewing needles in the
rust surrounding the sewing needles in the brain. Neurosurgery 1983;13:105-6.
brain may be a cause of headache.13 6. Rahimizadeh A, Sabouri-Daylami M,
There is no consensus on whether the Tabatabi M, et al. Intracranial sewing nee-
retained needles should be removed surgical- dles. Neurosurgery 1987;20:666.
Figure 1. Plain X-ray of the patient.
ly or not, and this issue has been the subject 7. Azariah RG. An unusual metallic foreign
of controversy in other reports.5,6 Surgical
body in the brain. Case report. J
interventions were reported in medulla oblon-
Neurosurg 1970;32:95-9.
gata lesions by needles in several cases.14-16
8. Unal N, Babayigit A, Karababa S, Yilmaz
In one case, extirpation of the needle using a
S. Asymptomatic intracranial sewing nee-
magnet proved useful.4 In another case, sub-
dle: an unsuccessful infanticide attempt?
occipital craniotomy was performed without
Pediatr Int 2005;47:206-8.
using electrocauterization and the needle was
9. Amirjamshidi A, Ghasvini AR, Alimoham-
withdrawn using a string.16 In the present
madi M, et al. Attempting homicide by
case, surgical intervention was not consid-
ered for two reasons: i) the needles were eval- inserting sewing needle into the brain.
uated as an incidental finding to the principle Report of 6 cases and review of literature.
complaint of headaches; and ii) potential sur- Surg Neurol 2009;6;635-41.
gical damage could worsen the patient’s qual- 10. Askenasy HM, Kosary IZ, Braham J.
ity of life. Sewing needles in the brain with delayed
neurological manifestation. J Neurosurg
1961;18:554-6.
11. Tuncer N, Yaycı N, Ekinci G, et al.
Conclusions Intracranial sewing needle in a man with
seizure: a case of child abuse? Forensic
Although the prevalence of cases of intracra- Sci Int 2007;24;168:212-4.
Figure 2. Three dimensional brain tomogra-
phy showing the position of the 3 needles. nial sewing needles is not common in the lit- 12. Amirjamshidi A, Abbassioun K, Amirjam-
erature, this may be due to the low associated shidi G. That is why people are frightened
survival rate. Surviving cases are mostly diag- of needles! Childs Nerv Syst 2009;25:907-
nosed by skull radiography after minor head 8.
injury.6,8 In our case, intracranial needles 13. Sturiale CL, Massimi L, Mangiola A, et al.
were found to be an incidental finding during Sewing needles in the brain: infanticide
evaluation of a patient for headache. The dis- attempts or accidental insertion? Neuro-
covery of 3 inserted needles was thought to be surgery 2010;67:E1170-9.
an interesting finding for the literature. 14. Abumi K, Anbo H, Kaneda K. Migration of
an acupuncture needle in to the medulla
oblongata. Eur Spine J 1999;5:137-9.
15. Hama Y, Kaji T. A migrated acupuncture
References needle in the medulla oblongata. Arch
Neurol 2004;61:1608.
1. Jinkins JR, Dadsetan MR, Sener RN, et al. 16. Takayashi K, Morimura N, Sakamoto T, et
Figure 3. Three dimensional brain tomogra- Value of acute-phase angiography in the al. Medullar injury caused by sewing nee-
phy showing the position of the 3 needles.
detection of vascular injuries caused by dle puncture. J Emerg Med 2011;40:65-7.
[page 86] [Neurology International 2012; 4:e18]

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Neurology International 2012; volume 4:e18

Intracranial metallic foreign Case Report Correspondence: Tuncay Kaner, Istanbul

[Neurology International 2012; 4:e18] [page 85]

[page 86] [Neurology International 2012; 4:e18]

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