Survival with good outcome after traversing brainstem injury: Case report

OBJECTIVE: A penetrating injury to the brainstem is usually a fatal injury. The number of cases in which the brainstem is traversed during the injury and the patient survives is exceedingly small. CLINICAL PRESENTATION: We report a case of an automobile collision in which blunt injury to the face of a 22-year-old man resulted in a fragment of the clivus being impacted posteriorly traversing through the pons in a left-sided through-and-through manner. The striking radiographic images demonstrate a potentially devastating brainstem injury. Surprisingly, the patient was able to follow commands and move his left side on arrival at the hospital. INTERVENTION: The patient required a temporary tracheostomy and underwent surgical repair of his facial fractures. His hospital course was complicated by meningitis, and he required a long stay on the rehabilitation service. The patient made a remarkable recovery and became able to converse and walk with assistance. He has been able to live independently. CONCLUSION: The striking radiographic images of this rare case illustrate an unusual pathology with an even more unusual outcome.