I.A. Andreev, A.I. Verkhovsky
(Dzhanelidze Hospital of Emergency Care, Saint Petersburg)
Patient A. sustained a head wound on December 1, 2001. It was inflicted by a metal arrow of a gun for underwater hunting. He was brought in moderate coma. A wounding agent projected from the lest orbit. Craniograms showed, that it was situated in the skull cavity in basal segment of the left hemisphere and perforated the squamous portion of the occipital bone on the left side. Carotid angiograms revealed no injury of major arteries of the left hemisphere and intracranial hematomas. There was no dislocation of median structures according to data of CT examination. We performed resection craniotomy in the left occipital area and removed a wounding agent. Active antibacterial therapy for prevention of infectious complications was carried out in a postoperative period.
Data of an ophthalmologic examination were indicative of primary atrophy of a disk of the left optic nerve due to its direct damage, amaurosis, ophthalmoplegy.
The demonstration purpose was to present a diagnostic algorithm and possibilities of active prevention of infectious complications in a severe craniocerabral wound, as well as to discuss moot problems of its classification.