A man in his 20s arrived at a UK hospital with the hilt of a knife protruding from his face after the 15 millimeter-wide blade pierced his right eye and traveled entirely through his brain, reaching the top of his skull.
Injury Assessment and Initial Treatment
The patient was conscious and alive upon arrival, able to speak and move all four limbs, although medical staff noted he was in an agitated state. He scored a 12 on the Glasgow Coma Scale, which signifies a moderate brain injury just above the mild threshold. His clinical presentation included opening his left eye upon verbal instruction, speaking and answering questions while remaining confused, and intentionally withdrawing from applied bodily pressure.
Medical professionals reporting on the incident in BMJ Case Report explained that they feared the man might attempt to extract the weapon himself due to his confusion and agitation. Consequently, they rapidly sedated and intubated him while administering preventive treatments for bacterial infections and tetanus before conducting imaging scans.
Neurosurgery and Recovery
Imaging revealed the blade had passed completely through the right eye socket and eyeball, crossing the left frontal and temporal lobes. The trajectory narrowly avoided the corpus callosum and the left internal capsule, two major bundles of nerve fibers connecting different parts of the brain. While the blade passed close to the primary left internal carotid artery without apparent harm, a branch of the middle cerebral artery appeared indented by the metal.
Following consultations across multiple medical specialties, surgeons performed emergency neurosurgery. They removed a portion of the skull to gain direct visibility into the brain and extracted the blade using a conservative technique rather than invasive excavation. Post-extraction, surgeons observed no major hemorrhaging, cleaned and drained the brain wound, and repaired the skull. Although the man’s right eye sustained too much damage to be saved and was removed, he is fine now.
