IJNT 2018; 15(02/03): 067-069
DOI: 10.1055/s-0039-1694295
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Penetrating Injury Due to Bicycle Brake Handle Causing Middle Cerebral Artery Infarct

Gopalakrishnan Madhavan Sasidharan
1  Department of Neurosurgery, Jawaharlal Institute of Post-graduate Medical Education and Research, (JIPMER), Pondicherry, India
,
Abhishek Chauhan
1  Department of Neurosurgery, Jawaharlal Institute of Post-graduate Medical Education and Research, (JIPMER), Pondicherry, India
› Author Affiliations
Further Information

Publication History

Received: 16 December 2017

Accepted after revision: 24 December 2018

Publication Date:
23 July 2019 (online)

Abstract

An 8-year-old boy was brought to the emergency room with history of fall from a bicycle he was riding. On examination, he had a swelling in the left orbit with a small laceration under the medial aspect of the left eyebrow. The Glasgow coma scale was E2M5V2. An emergency computed tomographic (CT) scan showed infarct causing mass effect in the territory of the left middle cerebral artery. CT angiogram showed that a branch of the middle cerebral artery was occluded at the end of track traversed by the bicycle brake handle. The patient underwent decompressive craniectomy. Initial methylmethacrylate cranioplasty had to be removed due to infection. Later, the patient underwent titanium cranioplasty. At last follow-up, he was going to school. Hemiparesis persisted. Children are vulnerable to penetrating injury by the relatively sharp brake handle when they fall from an adult bicycle. Previous reports include fatal injury by similar mechanism. In this case, it caused injury to the middle cerebral artery without causing bleed. Bicycle manufacturers could be advised to make the vehicle safer for children by twisting the end of the brake handle.