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Epilepsy caused by an unrecognized pencil lead misdiagnosed as intracerebral cavernous malformation

  • Keun Soo Lee
  • Bo Lyun LeeEmail author
Case Report
  • 12 Downloads

Abstract

Transorbital penetrating injury is relatively uncommon following head trauma, and delayed onset of neurological complications due to retained intracerebral foreign bodies has rarely been reported. We describe the first child case of late-onset epilepsy caused by an accidental transorbital penetrating injury, resulting in a retained pencil lead fragment that was mistaken for cavernous malformation. A 14-year-old girl presented with abrupt onset of nocturnal bilateral tonic seizures. The patient was previously healthy and denied any head trauma. The seizures were not well controlled by antiepileptic drugs. Right frontal lobe epilepsy due to a cavernous malformation was suspected on the basis of brain magnetic resonance imaging and electroencephalography findings. A planned operation unexpectedly revealed the intracerebral pencil lead. This foreign body had gone undetected for 11 years following a minor transorbital penetrating injury. The patient remained seizure-free during the 1-year post-operative follow-up period. Head trauma by a pencil can cause transorbital penetrating injury in children. It is difficult to detect retained small foreign body fragments and the clinical presentation can be delayed. It may be mistakenly diagnosed as other pathologies, especially when patients deny any history of head trauma.

Keywords

Epilepsy Cavernous malformation Foreign body Head trauma 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

References

  1. 1.
    Inci S, Karakoc E, Saygi S, Ozgen T (2006) Unrecognized intracerebral glass particle mimicking cavernoma: case report. Neurosurgery 58:E203.  https://doi.org/10.1227/01.neu.0000192387.03428.e1 CrossRefPubMedGoogle Scholar
  2. 2.
    Gupta A, Chacko A, Anil MS, Karanth SS, Shetty A (2011) Pencil in the brain: a case of temporal lobe abscess following an intracranial penetrating pencil injury. Pediatr Neurosurg 47(4):307–308.  https://doi.org/10.1159/000336882 CrossRefPubMedGoogle Scholar
  3. 3.
    Chunhua Q, Qun W (2014) A late-onset seizure due to a retained intracranial foreign body--pencil lead: a case report and review. J Craniofac Surg 25(2):e109–e110.  https://doi.org/10.1097/SCS.0000000000000439 CrossRefPubMedGoogle Scholar
  4. 4.
    Cho WK, Ko AC, Eatamadi H, Al-Ali A, Abboud JP, Kikkawa DO, Korn BS (2017) Orbital and orbitocranial trauma from pencil fragments: role of timely diagnosis and management. Am J Ophthalmol 180:46–54.  https://doi.org/10.1016/j.ajo.2017.05.018 CrossRefPubMedGoogle Scholar
  5. 5.
    Reisch R, Perneczky A, Filippi R (2003) Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 59(3):223–227.  https://doi.org/10.1016/s0090-3019(02)01037-6 CrossRefPubMedGoogle Scholar
  6. 6.
    Reisch R, Stadie A, Kockro R, Gawish I, Schwandt E, Hopf N (2009) The minimally invasive supraorbital subfrontal key-hole approach for surgical treatment of temporomesial lesions of the dominant hemisphere. Minim Invasive Neurosurg 52(4):163–169.  https://doi.org/10.1055/s-0029-1238285 CrossRefPubMedGoogle Scholar
  7. 7.
    Zimmermann LL, Martin RM, Girgis F (2017) Treatment options for posttraumatic epilepsy. Curr Opin Neurol 30(6):580–586.  https://doi.org/10.1097/WCO.0000000000000505 CrossRefPubMedGoogle Scholar
  8. 8.
    Christensen J (2015) The epidemiology of posttraumatic epilepsy. Semin Neurol 35(3):218–222.  https://doi.org/10.1055/s-0035-1552923 CrossRefPubMedGoogle Scholar
  9. 9.
    Rao VR, Parko KL (2015) Clinical approach to posttraumatic epilepsy. Semin Neurol 35(1):57–63.  https://doi.org/10.1055/s-0035-1544239 CrossRefPubMedGoogle Scholar
  10. 10.
    Bursick DM, Selker RG (1981) Intracranial pencil injuries. Surg Neurol 16(6):427–431.  https://doi.org/10.1016/0090-3019(81)90235-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Herman TE, Shackelford GD, Tychsen L (1995) Unrecognized retention of intraorbital graphite pencil fragments: the role of computerized tomography. Pediatr Radiol 25(7):535–537.  https://doi.org/10.1007/bf02015787 CrossRefPubMedGoogle Scholar
  12. 12.
    Wang KY, Idowu OR, Lin DDM (2017) Radiology and imaging for cavernous malformations. Handb Clin Neurol 143:249–266.  https://doi.org/10.1016/B978-0-444-63640-9.00024-2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Busan Paik HospitalInje University College of MedicineBusanSouth Korea
  2. 2.Division of Pediatric Neurology, Department of Pediatrics, Busan Paik HospitalInje University College of MedicineBusanSouth Korea

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