=Acta

Acta Neurochir (Wien) (19891) 97:111 113

N-eurochirurgica 9 by Springer-Verlag1989

Stunning Device as a Suicide Weapon B. Klun and V. Jankovi~ Department of Neurosurgery, University Medical Center, Ljubljana, Yugoslavia

Summary

Material

Thirteen patients who had attempted suicide with the stunning device, were treated over a time span of eleven years. Five of them died. The survivors made a satisfactory recovery with minor neurological sequelae only. The characteristics of this type of brain injury are: high incidence of infection (all developed meningitis and six of them brain abscesses), with prevalence of gram negative animal strains and technical difficulties in removing foreign bodies from the deeper part of the missile track.

Thirteen patients were treated between 1976 and 1986. All but one were males. The entry wound was temporal in 12 and occipital in one case. Consciousness was decreased in all cases. Six patients were sleepy but arousable and seven were comatose. Five had otherwise no gross neurological deficit, six had hemiparesis, two hemiplegia and one an additional lesion of the optic nerve. The operative procedure consisted of debridement of the wound, removal of hair, bone fragments and obviously destroyed brain tissue, evacuation of haematoma, which in none was space occupying, and reconstruction of the dura. The procedure was performed as an emergency in nine patients and delayed in two, considered lost at admission. Two patients were moribund and no operation was carried out.

Keywords: Penetrating brain injury; suicide attempt; stunning device.

Introduction A t t e m p t s at suicide with the stunning device are infrequent. O n l y o c c a s i o n a l r e p o r t s dealing with small n u m b e r s have been published. L a u s b e r g 5 collected 41 cases f r o m the literature a n d a d d e d one o f his own. It is therefore surprising t h a t a r a t h e r large n u m b e r o f suicidal p a t i e n t s were a d m i t t e d to o u r D e p a r t m e n t within the last eleven years. Since all the patients c a m e f r o m a relatively small a r e a o f a b o u t 900,000 i n h a b i tants, covered b y this D e p a r t m e n t , it r e m a i n s unclear w h e t h e r such high incidence represents a mere coincidence o r a r e g i o n a l characteristic. The s t u n n i n g device (Fig. 1) is used in slaughtering cattle a n d o c c a s i o n a l l y hogs. The stunning effect is caused b y a pin driven b y a bullet-free cartridge. A l l the p a t i e n t s were either b u t c h e r s o r farmers, p e o p l e w h o are well a c q u a i n t e d with s l a u g h t e r h o u s e techniques o f killing cattle a n d who also h a d the opp o r t u n i t y for o b t a i n i n g such a device. I n p l a n n i n g the suicide, they were u n d o u b t e d l y i m p r e s s e d by the effect o f the device on sizable cattle, b u t o v e r l o o k e d the fact t h a t it k n o c k s the a n i m a l unconscious, b u t t h a t d e a t h occurs b y e x s a n g u i n a t i o n .

Results The p a t i e n t s ' d a t a are given in T a b l e 1.

Discussion The use o f a stunning device as a suicide w e a p o n has been r e p o r t e d m o s t l y in the G e r m a n literature 1' 2, 4,5

Fig. 1. Stunning device with the cartridges. Observe the concave tip of the pin

B. Ktun and V. Jankovi6: Stunning Device as a Suicide Weapon

I12 Table 1

Number

Sex Age Status at admission

Statusat discharge

1

M

54

mild hemiparesis

2

M

53

3 4

M M

47 51

5 6

M F

73 51

7 8

M M

54 45

9 10

M M

58 41

11

M

35

t2 13

M M

40 46

somnolent, hemiparesis comatose, hemiparesis comatose comatose, hemiplegia somnolent somnolent, hemiparesis somnolent comatose, hemiparesis somnolent coma, hemiparesis comatose, hemiparesis, left optic nerve lesion somnolent comatose

death mental changes death no deficit mild hemiparesis no deficit death

Fig. 2. CT-scan of a patient at admission (left). Six months later, the patient developed encephalitis around a bone fragment at the end of the track (right) missed in the first scan, to which he succumbed in spite of the operation

no deficit death hemiparesis, blindness-left eye no deficit death

It seems that the so-called nailer, used in the construction business, is becoming more popular in assaults, as well as in suicide attempts. Olumide and Adeloye 6 reported two patients, Wu and Shih described two similar cases and G r a h m and Carrion published another such case. In these reports the injury involved the sagittal sinus with subsequent haemorrhage. In our patients haemorrhage was never an important factor. The main problem was an extremely high rate of infection in spite of antibiotic treatment started from the beginning in all cases. This m a y be explained by the fact that the pins are, as a rule, highly contaminated with mostly gram negative strains of animal bacteria. These wounds are therefore not comparable to the fire arm wounds, where the bullet exerts a "self-sterilizing" property, developing high temperatures when passing through the barrel. On the other hand, the narrow, but deep missile track makes it difficult to remove all necrotic tissue, an excellent ground for subsequent infections. Another characteristic finding was the presence of a small bone fragment at the end of the pin track, due to the particular concave tip of the pin (Fig. 2). Gerlach 2 made the same observation. This fragment, difficult to localize and to remove, was the cause of death in one of our patients. As a consequence of infection, all the patients developed meningitis and six of them brain

abscesses. The infection was the cause of death in three patients. Neurological deficit corresponded to the location of the wound. The relatively low temporal entry wound in all the patients but one, explains the small number of focal, especially pyramidal signs. In all temporal wounds, the non-dominant hemisphere was involved. The optic nerve lesion in one patient remained permanent. Five patients out of thirteen died. The mortality rate is rather moderst in comparison with similar series and approximately the same as that for civilian gunshot wounds. Lausberg s found among 42 patients just six survivors, but only three of them had intracranial penetration. Jacoby's five patients all died shortly after operation. It is therefore surprising that most of the survivors made a satisfactory recovery after a protracted course. Four out of eight had no neurological deficit and the remainder showed neurological sequelae of different degrees. On the basis of these findings, it seems to us that the treatment of these injuries should be oriented to the debridement of the dead tissue, aggressive removal of all foreign bodies, especially bone fragments and hair, watertight closure of the dura and prolonged antibiotic treatment, beginning at the time of admission, using drugs covering the gram negative spectrum.

References 1. Bushe KA, Wenker H (196I) Schfidel-Hirnverletzungen durch verschiedene Bolzenschussapparate. Chirurg 32:539-544 2. Gerlach J (1955) Ueber Bolzenschussverletzungen des Gehirns. Zentralbl Neurochir 15:83-87

B. Klun and V. Jankovi6: Stunning Device as a Suicide Weapon 3. Grahm TW, Carrion CC (1987) Penetrating cranial cerebral injury from a modern air-powered nailer: a case report. BNI Quarterly 3:35-37 4. Jacoby W (1959) Bolzenschussverletzungen des SchS.dels. Chirurg 30:423M26 5. Lausberg G (1963) Ueber offene Hirnverletzungen durch Schussapparatbolzen. Chirurg 34:151-154

113 6. Olumide AA, Adeloye A (1976) Unusual cranio-cerebral injuries: report of two cases in Nigerians. Surg Neurol 6:306-308 7. Wu JJ, Shih CJ (1982) Unusual penetrating injury of the superior sagittal sinus. Surg Neurol 17 (1): 43-46 Correspondence and Reprints: Prof. Boris Klun, MD., D.Sc., Department of Neurosurgery, University Medical Center, Zalo~ka 7, Ljubljana, Yugoslavia.