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Paper text:
intracranial foreign bodies such as needle , wooden and bullets are generally due to penetrating injuries through the orbita , ear or cranial bones or rarely forgotten surgical objects in the brain during surgery .
most of the cases were diagnosed incidentally and/or during evaluation for symptoms such as headache , epilepsy or altered behavior .
patients , who presented with seizure due to intracranial needles , were rarely reported previously .
we report a 14-year - old boy with epilepsy resulting from the presence of sewing needle located in the brain .
a 14-year - old boy was admitted to the pediatric neurology outpatient department with a history of generalized tonic - clonic ( gtc ) seizures .
there were no previous history of epileptic seizures , head trauma or injury and his family history was unremarkable . on admission his neurological examination was normal , there were no localizing neurological findings or lateralized weakness .
after his second seizure sodium valproate treatment ( 20 mg / kg / day ) was started . to determine etiology of seizures cranial magnetic resonance imaging was obtained and magnetic susceptibility artifact in right frontal region was seen ( figure 1 ) . to reveal the nature of the object computed tomography ( ct )
was obtained , which showed a linear density compatible with a sewing needle surrounded with a local encephalomalacic area and calcification ( figure 2 ) .
also , skull radiography demonstrated the presence of metallic opacity of a sewing needle , located in a cranio - caudal direction on the right frontal area ( figure 3 ) .
based on the needle s location , we thought that it might have been inserted through the anterior fontanel during infancy .
the needle was encrusted with an irregular gliotic area ( figure 4 ) . during the postoperative 8 months he was seizure - free with valproic acid treatment .
two months after discontinuing valproic acid treatment his seizure reoccurred and a spike wave activity in the right frontal region was determined in his eeg . in the two
there are reports of sewing needles and other foreign objects retained in the brain for long periods of time without any symptoms .
since its first description in 1914 , approximately forty cases have been reported all over the world , which were reviewed by struiale et al . in this review ,
about one third of patients with intracranial needles were asymptomatic and had been discovered incidentally .
the most seen complaint was long time history of slight headache and secondly was seizure .
initial complaints such as fever , hemiparesis , extrapyramidal signs , cranial nerve palsy , hemi - chorea , brain abscess , nausea , vomiting , lethargy , hemorrhage , meningitis and rarely hypothalamic syndrome had also been reported in this review .
the underlying pathophysiologic mechanism of seizures linked to intracranial foreign bodies is not clearly understood .
reported that persistent epilepsy after penetrating brain injuries is as high as 50% at 15 years after the injury , 85% in cases with longer follow - up .
hypothesized that the needle can function as an electric dipole and can be the main reason for epileptogenesis .
although we could not identify any abnormality in his first awake / sleep eeg , his postoperative eeg showed spike wave activity in the same area with the needle in our case .
therefore we thought that the area of gliosis around the needle might be a possible reason for seizures then the needle .
the most widely accepted approach is to follow - up without surgical removal when the patients have no clinical signs or symptoms and the diagnosis is purely incidental .
the excision of the cortical scar tissue at the sewing needle entrance is highly recommended , especially if there are preoperative eeg abnormalities .
we preferred to remove the needle surgically because of the early presentation of the patient with seizure .
most frequently , the patients and their relatives have no idea about how and when the needle was inserted . in most cases , as in ours , the needle presumably was introduced in infancy before the closure of the fontanels ; therefore the patient can not remember anything .
although it is thought that the needle inserted accidently , the conditions such as introduction of the needle by another child without the awareness of parents or other family members and child abuse should be strongly considered in these cases . in conclusion , although there are no clear - cut guidelines regarding the management of these foreign bodies , follow - up with antiepileptic treatment before surgery might be a reasonable approach to the patients with seizure .
placing of sewing needles in the brain through the anterior fontanel is a rare entity . 
 there are very few cases reported in literature . 
 most of them were asymptomatic , but some of them presented with seizure . 
 we report here a 14-year - old boy , who was admitted to the pediatric neurology department with a history of generalized tonic - clonic seizures due to sewing needle located in the frontal lobe .