Twisted steel-induced penetrating head injury.

Penetrating head injury causes complex injuries and high mortality. A 47-year-old man presented after a fall from a 4-meter-high construction scaffold with a twisted steel bar in his head (figure, A and B). The only focal neurologic deficit was a fixed and dilated left pupil. CT imaging revealed interruption of left optic canal (figure, C) without involvement of left internal carotid artery (figure, D) or cavernous sinus (figure, E). After a combined neurosurgical and maxillofacial operation, the patient recovered without intracranial infection or abscess, CSF leakage, or epilepsy. Except for left eye blindness, no neurologic sequelae were observed 1 month after surgery.