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. 2024 Nov 25;8(22):CASE24494.
doi: 10.3171/CASE24494. Print 2024 Nov 25.

Penetrating intracranial injury from a pencil in a pediatric patient: illustrative case

Eva Liu  1 , Hsuan Ming Su  1 , Patrick Toyota  1 , Braeden D Newton  1 , Nicole Coote  1 , Kristen Marciniuk  1 , Syed Uzair Ahmed  1 , Michael E Kelly  1 , Lissa Peeling  1
Affiliations

Penetrating intracranial injury from a pencil in a pediatric patient: illustrative case

Eva Liu et al. J Neurosurg Case Lessons. .

Abstract

Background: Intracranial penetrating injuries from a pencil are exceptionally rare. The most common mechanism is a child running while holding a pencil. Potential consequences of intracranial pencil injury include direct trauma to brain structures, vascular injury, and intracranial abscess formation.

Observations: A 3-year-old girl was at daycare and had fallen while running with a pencil. Computed tomography showed a pencil penetrating the left parietal bone through the left temporal lobe, terminating in the posterior limb of the internal capsule. Cerebral angiography was performed prior to the removal of the pencil to rule out vascular injury. Angiography of the left carotid artery revealed slight irregularity in the left M2 but no active extravasation. The patient was then taken to the operating room to have the pencil removed. Postoperatively, she did well and was discharged home after 6 days with no neurological deficits.

Lessons: Pencils are rare causes of intracranial injury in children. Definitive vascular imaging prior to pencil removal to rule out vascular injury and minimize the risk of hemorrhage after removal is recommended. Intraoperative irrigation and debridement, followed by antibiotics, are recommended to avoid abscess formation. Follow-up vascular imaging is recommended to rule out pseudoaneurysm. https://thejns.org/doi/10.3171/CASE24494.

Keywords: foreign object; pediatrics; pencil; penetrating intracranial injury.

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Figures

FIG. 1.
FIG. 1.
A: CT image showing a pencil penetrating through the left temporal lobe and terminating in the posterior limb of the internal capsule. B: 3D CT reconstruction of the head showing the pencil entering the left parietal bone.
FIG. 2.
FIG. 2.
Cerebral angiogram (A) and 3D reconstruction of the cerebral angiogram (B) showing focal irregularity (red and white arrows) of the left M2 and cortical branch but no active contrast extravasation.
FIG. 3.
FIG. 3.
A: Pencil extruding from the left side of the head. B: Intraoperative image of the pencil extruding from the left parietal bone.
See this image and copyright information in PMC

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