title: Delayed diagnosis of intracranial injury due to a dog bite--a case report and review of the literature.
abstract: OBJECTIVE
  Dog bite injury of the head and neck is not rare in children although intracranial injury is reported anecdotally. Among the case reports there is a significant number of patients in whom the diagnosis of penetrating cranial injury was delayed. The aim of the study was to describe a patient with a trans mastoid head injury due to a dog bite that was not diagnosed at presentation and review similar cases in the literature.
  
  
  METHODS
  A 13-year-old girl was admitted to the emergency room with severe head, neck and breast lacerations. She was transferred to the operating room for debridement and only then was a trans mastoid fracture diagnosed. We searched for case reports in the literature describing children suffering from dog bites in whom the diagnosis of intracranial injury was delayed.
  
  
  RESULTS
  We found descriptions of five children, 4 after dog bite and one after tiger bite. Four of them were under two years of age and all had scalp lacerations that were treated at presentation. The time period to diagnosing the brain injury was one day to three weeks. The symptoms that led to the diagnosis were fever in 3 patients, meningitis in two, brain abscess in one child and four of them developed neurological signs. All of the children had surgical intervention after diagnosis.
  
  
  CONCLUSIONS
  Intracranial injury after dog bite should be suspected in any child with scalp lacerations. Adequate investigations should be performed at presentation with careful attention to this specific type of trauma.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Shay
authors.initials: S
authors.lastname: Froind
authors.forename: Angelica Shapira
authors.initials: AS
authors.lastname: Parra
authors.forename: Nili
authors.initials: N
authors.lastname: Segal
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003646:Debridement; D057210:Delayed Diagnosis; D004285:Dogs; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D022125:Lacerations / Q000175:diagnosis / Q000601:surgery; D008416:Mastoid / Q000000981:diagnostic imaging / Q000293:injuries*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery
keywords: Children; Delayed diagnosis; Dog bite; Intracranial injury