title: Good clinical practice in dubious head trauma - the problem of retained intracranial foreign bodies.
abstract: OBJECTIVE
  In young people, traumatic head and brain injuries are the leading cause of morbidity and mortality. In some cases, no neurological deficits are present, even after penetrating trauma. These patients have a greater risk of suffering from secondary injuries due to secondary infections, brain edema, and hematomas. We present a case report which illustrates that brain injuries that do not induce neurological deficits can still result in a fatal clinical course and death, with medicolegal consequences.
  
  
  METHODS
  A 19-year-old patient was admitted to hospital suffering from a head injury due to an assault. He reported that he was attacked from behind. Medical examination showed no neurological deficits, and only a small occipital wound. Neuroimaging of the cranium revealed that a knife blade was penetrating the cranial bone and touching the superior sagittal sinus.
  
  
  METHODS
  After removing the foreign body, magnetic resonance imaging showed that the superior sagittal sinus remained open.
  
  
  CONCLUSIONS
  We want to stress that possible problems can arise due to the retention of objects in the cranium, while also highlighting the risk of superficial clinical examination.
authors.affiliation: Department of Neurotraumatology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Bernhard R
authors.initials: BR
authors.lastname: Fischer
authors.forename: Yousef
authors.initials: Y
authors.lastname: Yasin
authors.forename: Markus
authors.initials: M
authors.lastname: Holling
authors.forename: Volker
authors.initials: V
authors.lastname: Hesselmann
keywords: guidelines; head trauma; neuroimaging; retained object