A man in his 20s arrived at a UK hospital with the hilt of a knife sticking out of his face, after the 15 mm blade went completely through his right eye and brain, its tip reaching the top of his skull. Despite the injury he was alive and conscious, able to talk and move all four limbs, although the doctors who treated him described him as agitated.
In a report published Friday in BMJ Case Report, the man's doctors described his injury as a "moderate" brain injury on the Glasgow Coma Scale, on which he scored 12, one point above "mild". He could open his left eye when told to but otherwise kept it closed, could answer questions although he was confused, and intentionally moved away when pressure was applied to his body.
Concerned that in his confused, agitated state he might try to pull the knife out on his own, the doctors swiftly sedated and intubated him and began prophylactic treatment for bacterial infections, including tetanus. They then used imaging to see what was going on in his head.
Analysis
Why This Matters
- The case is a rare, documented example of a blade passing through the eye and brain while the patient remained conscious and able to answer questions, a scenario emergency and trauma teams rarely encounter.
- It shows a specific bedside danger: a confused patient with an embedded blade may try to remove it, so the treating team sedated and intubated him before imaging could be done.
- The report provides a detailed clinical record, from coma-scale scoring to infection prophylaxis, that hospitals can refer to when managing penetrating head injuries.
Background
The Glasgow Coma Scale is the standard clinical tool for grading consciousness after a brain injury, scoring eye, verbal and motor responses from 3 to 15, with lower scores indicating deeper impairment. Scores of 13 to 15 are generally regarded as mild, so a score of 12 sits at the boundary of what doctors class as moderate. Penetrating wounds that pass through the eye into the brain are uncommon, and arriving conscious with such a wound is exceptional.
What to Watch
- Follow-up from the treating team on the man's progress after the sedation, infection treatment and imaging described in the report.
- Whether the case prompts wider discussion in emergency medicine about keeping patients with embedded blades from harming themselves while awaiting imaging and surgery.
