Abstract
An 8-year-old boy was brought to the emergency room with history of fall from a bicycle
he was riding. On examination, he had a swelling in the left orbit with a small laceration
under the medial aspect of the left eyebrow. The Glasgow coma scale was E2M5V2. An
emergency computed tomographic (CT) scan showed infarct causing mass effect in the
territory of the left middle cerebral artery. CT angiogram showed that a branch of
the middle cerebral artery was occluded at the end of track traversed by the bicycle
brake handle. The patient underwent decompressive craniectomy. Initial methylmethacrylate
cranioplasty had to be removed due to infection. Later, the patient underwent titanium
cranioplasty. At last follow-up, he was going to school. Hemiparesis persisted. Children
are vulnerable to penetrating injury by the relatively sharp brake handle when they
fall from an adult bicycle. Previous reports include fatal injury by similar mechanism.
In this case, it caused injury to the middle cerebral artery without causing bleed.
Bicycle manufacturers could be advised to make the vehicle safer for children by twisting
the end of the brake handle.
Keywords
penetrating injury - infarct - cranioplasty - bicycle brake handle injuries
