We report a case of a possible association between intracranial needles and headaches. There are previously reported cases of sewing needles and other foreign objects retained in the brain for long periods of time without any symptoms. In our case, the intracranial needles were detected after a long period of time. During that period, the intensity, duration and localization of the headache altered as did the accompanying symptoms. All other reported cases except one describe single intracranial metallic objects. The radiological findings in our patients strongly suggest that three needles had been introduced into the brain.
A variety of penetrating objects of the skull and brain have been reported, including blades, nails, pencils, splinters of wood and wire.4
Intracranial foreign bodies are usually due to penetrating injuries through the cranial bones, orbits and ear.1–3
Intracranial sewing needles have been previously reported in the literature.5–9
It has also been reported that surgical objects may be left in the brain during surgery.10
The radiological findings in our patient demonstrated that intracranial foreign bodies resembled sewing needles. The locations of these objects suggested that intracranial needles might have been inserted through the cranium during infancy before the closure of the fontanelle. The intracranial location of the sewing needles are thought to be the result of an unsuccessful infanticide attempt or of an accident during infancy.7,11
Amirjamshidi et al.
suggested that this is a kind of so called battered child syndrome phenomenon
which might have been traditional and prevalent in some communities.12
This kind of accident might also have been due to another child poking a baby with a couple of needles, or the child could have done it himself, and can not remember the event as an adult.
In clinical practice, many physicians prefer magnetic resonance imaging (MRI) to evaluate intractable headache. It might be possible to see cases like that of our patient especially in developing countries and MRI could have disastrous consequences. Therefore, it becomes more important to make a gradual evaluation of pain step by step and an MRI should not be ordered immediately. The problem of headache in similar cases is not usually clear. Some authors have suggested that the biochemical composition of the iron rust
surrounding the sewing needles in the brain may be a cause of headache.13
There is no consensus on whether the retained needles should be removed surgically or not, and this issue has been the subject of controversy in other reports.5,6
Surgical interventions were reported in medulla oblongata lesions by needles in several cases.14–16
In one case, extirpation of the needle using a magnet proved useful.4
In another case, sub-occipital craniotomy was performed without using electrocauterization and the needle was withdrawn using a string.16
In the present case, surgical intervention was not considered for two reasons: i) the needles were evaluated as an incidental finding to the principle complaint of headaches; and ii) potential surgical damage could worsen the patient's quality of life.