Wednesday, January 6, 2016

Child abuse and sewing needles

Kazanci A, Ozdemir HI, Kazanci B, Kazanci DO, Er U. Intracranial sewing
needles in an adult patient. Turk Neurosurg. 2012;22(6):775-6.


A 37-year-old patient is reported with intracranial sewing needles, which were located in the right frontal lobe. Both clinical and radiological findings suggested that these needles must have been introduced in infancy before the closure of anterior fontanelle during an unsuccessful homicide. Usually intracranial foreign objects are placed due to penetrating trauma or surgical procedures. Child abuse has been known for centuries. Many types of physical traumas have been reported, especially in Western countries. In Iran, insertion of sewing needles into the brain aiming to kill the infant have been seen in a lot of cases. This situation takes part in a lot of Persian stories. We reported a 37-year-old man who had 2 intracranial sewing needles with unknown etiology.

Tuncer N, Yayci N, Ekinci G, Inanici MA, Elmaci I. Intracranial sewing needle
in a man with seizure: a case of child abuse? Forensic Sci Int. 2007 May


Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.

Sener RN. Intracranial sewing needles in a 20-year-old patient. J Neuroradiol.
1997 Oct;24(3):212-4.


A 20-year-old patient is reported with three intracranial sewing needles, which were located in the frontal lobes. The clinicoradiologic findings strongly suggested that they must have been placed into the brain through the anterior fontanelle during an unsuccessful homicide attempt in infancy.

Amirjamshidi A, Ghasvini AR, Alimohammadi M, Abbassioun K. Attempting homicide
by inserting sewing needle into the brain Report of 6 cases and review of
literature. Surg Neurol. 2009 Dec;72(6):635-41; discussion 641.



Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.


The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed.


Among the 4 patients who underwent surgery, 1 died after a short period of 'akinetic mutism.' Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr.


In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life.


1 comment:

  1. Tun K, Kaptanoglu E, Turkoglu OF, Celikmez RC, Beskonakli E. Intracranial sewing needle. J Clin Neurosci. 2006 Oct;13(8):855-6.


    A 45-year-old patient was found to have an intracranial sewing needle, located in the left frontal lobe. The needle was detected incidentally after minor head trauma. The clinical and radiological findings suggested that it might have entered the brain through the anterior fontanelle.