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Aim To review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing. Methods A review of the current literature was performed. Results Of patients with craniocerebral GSW, 66–90 % die before reaching hospital. Of those who are admitted to hospital, up to 51 % survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13–17 % of all gunshot injuries. Conclusions Urgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4–5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

Traumatic brain injury leads to a highly orchestrated immune- and glial cell response partially responsible for long-lasting disability and the development of secondary neurodegenerative diseases. A holistic understanding of the mechanisms controlling the responses of specific cell types and their crosstalk is required to develop an efficient strategy for better regeneration. Here, we combine spatial and single-cell transcriptomics to chart the transcriptomic signature of the injured male murine cerebral cortex, and identify specific states of different glial cells contributing to this signature. Interestingly, distinct glial cells share a large fraction of injury-regulated genes, including inflammatory programs downstream of the innate immune-associated pathways Cxcr3 and Tlr1/2. Systemic manipulation of these pathways decreases the reactivity state of glial cells associated with poor regeneration. The functional relevance of the discovered shared signature of glial cells highlights the importance of our resource enabling comprehensive analysis of early events after brain injury. Glial cells and their crosstalk after injury are crucial for brain regeneration. Here, the authors show the spatial, temporal, and single-cell responses of glial cells after injury and identify shared pathways controlling glial reactivity.

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines. The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation. A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively. Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site. [Display omitted] •SCISW mainly affects young males and most commonly localizes in the thoracic region.•CT scan and plain radiographs are necessary to exclude retained foreign bodies.•MRI can confirm the SCI and may be useful as a predictor of outcomes.•Conservative treatment should be preferred over surgery in the absence of a foreign body.

In forensic practice, spinal cord injury (SCI) resulting in death has rarely been reported. Here, we present the case of a 65-year-old woman who on admission was conscious without dyspnea or dysphagia. Physical examination revealed two sharp objects penetrating the neck: a pair of scissors lodged in the neck on the right side of the thyroid cartilage and a knife embedded in the nuchal region accompanied by minor seepage of bloody exudate. Radiography showed that the scissors and knife were retained in the cervical spine. Despite a series of medical interventions, the patient died 26 days later. Method: A systematic forensic autopsy was performed. Results: The cause of death was confirmed to be respiratory failure associated with SCI, which was caused by the combination of scissors and a knife. Conclusion: Based on this case, we believe that when there are multiple causes of death, forensic pathologists should determine the primary, immediate, contributory, and other causes of death to ascertain criminal responsibility.

Previous studies have shown that estradiol reduces reactive gliosis after a stab wound injury in the cerebral cortex. Since the therapeutic use of estradiol is limited by its peripheral hormonal effects, it is of interest to determine whether synthetic estrogenic compounds with tissue-specific actions regulate reactive gliosis. Tibolone is a synthetic steroid that is widely used for the treatment of climacteric symptoms and/or the prevention of osteoporosis. In this study, we have assessed the effect of tibolone on reactive gliosis in the cerebral cortex after a stab wound brain injury in ovariectomized adult female mice. By 7 days after brain injury, tibolone reduced the number of glial fibrillary acidic protein (GFAP) immunoreactive astrocytes, the number of ionized calcium binding adaptor molecule 1 (Iba1) immunoreactive microglia, and the number of microglial cells with a reactive phenotype in comparison to vehicle-injected animals. These effects on gliosis were associated with a reduction in neuronal loss in the proximity to the wound, suggesting that tibolone exerts beneficial homeostatic actions in the cerebral cortex after an acute brain injury.

Pencil-core granuloma is characterized by a delayed granulomatous foreign body reaction against degraded and diffusely dispersed graphite, the main component of pencil-core materials. Because pencil lead is a ceramic composite of graphite and clay and is sealed with waxes, it does not elicit immediate reactions. However, the core can gradually decompose over decades, dissolve and be phagocytosed, resulting in a granulomatous reaction. Here, Matsuoka et al examine the case of a 72-year-old man with pencil-core granuloma.

Background:Tube thoracostomy (TT) is the standard treatment for haemothorax, but 5–30% of cases may result in retained haemothorax. Video-assisted thoracoscopy surgery (VATS) is a recognised treatment for retained haemothorax, although its timing and feasibility can be challenging in resource-limited settings with restricted theatre access. The objective was to evaluate and describe our experience with VATS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.Methods:This was a retrospective study over seven years (1 January 2017 – 31 December 2023). All adult trauma patients with retained haemothorax who underwent VATS were included. Data were collected from hospital databases, focusing on patient demographics, mechanism of injury, vital signs, radiological findings, indications for VATS, and clinical outcomes.Results:A total of 71 patients underwent VATS, with 98.6% being male and an average age of 34 years. The procedure was performed for retained haemothorax in 97% (n = 69) of cases and empyema in two patients. Penetrating trauma was the most common cause, with 82% of patients suffering stab wounds and 18% gunshot wounds. The median time to surgery was 5 days, with a median operating time of 77 minutes.Conversion to thoracotomy occurred in 14% (n = 10) of cases. Intraoperative findings included clots (42%), retained blood (42%), and pus (2.8%). Postoperative complications occurred in 12.7% (n = 9), including pneumonia (2.8%), drain site infections (5.6%), and recurrence of haemothorax (4.2%). The median length of hospital stay after VATS was 6 days, with no in-hospital mortalities.Conclusions:VATS is a safe and feasible option for managing penetrating chest trauma in resource-constrained environments, with low complication rates and low in-hospital mortality rates.

Intrauterine fetal demise due to penetrating abdominal trauma is rare, and complete umbilical cord transection is exceptionally uncommon. We report the case of a 29-week pregnant woman who sustained multiple abdominal stab wounds, leading to fetal death and complete transection of the umbilical cord. The maternal and fetal risks associated with trauma rise significantly with gestational age. Despite advances in emergency care, management of trauma in pregnancy remains complex and lacks standardized protocols. A multidisciplinary approach in specialized settings is essential to improve maternal and fetal outcomes. This case is reported due to its rarity and to underscore the importance of early recognition and coordinated intervention in traumatic injuries during pregnancy.

IntroductionTraumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes.MethodsA literature search was performed on MEDLINE Complete-Pubmed from 1829–2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. Inclusion criteria: patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF’s. Exclusion criteria: articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded.ResultsThere were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)—126 (43.3%), Gunshot wounds (GSW)—94 (32.3%), miscellaneous—35 (12%), mechanism unspecified—36 (12.4%). Anatomic area: neck—69 (23.7%) patients, thorax—46 (15.8%), abdomen—87 (30%), upper and lower extremities—89 (30.6%). Most commonly involved vessels—vertebral artery—38 (13%), popliteal vein—32 (11.7%). Angiography was diagnostic—265 patients (91.1%). Interventions: Surgical– 202 (59.6%), Endovascular—118 (34.8%). Associated: aneurysms/pseudoaneurysms—129 (44.3%).ConclusionMost AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.

Background Position changes in patients with thoracic spinal stab wounds may cause displacement of embedded sharp objects, increasing the risk of spinal cord or surrounding tissue injury. Management of these cases under anesthesia requires a carefully planned approach to minimize movement and ensure patient safety. Case presentation A 59-year-old Han Chinese male was admitted to the hospital due to “back pain and bleeding caused by stab wounds for 2 hours.” The patient was at high risk of secondary spinal cord injury and aspiration due to an embedded foreign object and a full stomach state. Fiberoptic bronchoscopy-guided endotracheal intubation was successfully performed in the prone position under mild sedation. Conclusion This case highlights the feasibility and safety of awake fiberoptic bronchoscopy-guided intubation in the prone position and provides valuable insights for managing similar high-risk scenarios in clinical practice.