AN ARROW IN THE HEAD- A NEURO-PSYCHIATRIC

On 4th November 1988, the patient was admitted to a private medical centre with a penetrating wound of his head and an arrow sticking out (Figure 1). On examination, he was not opening his eyes and not talking. He appeared to be unconscious. His pupils were equal and reactive. The reflexes were symmetrical. An arrow penetrating the frontal region just to the left of the midline was seen. CT Scan of the brain (Figure 2) showed complete penetration of the left side of the head 78 Tan Chee Khuan et. al. with an antero-posterior direction by an arrow. Frontal and occipital craniotomies were performed and the penetrating object was removed. Post-operative recovery was quite slow. He was able to obey commands and by two weeks the weakness of his right upper limb improved. He was able to express himself in writing, but was unable to talk. On discharge six weeks later, he was fully alert and was able to comprehend spoken language well. He was able to recognize written speech and write spontaneously, but still unable to talk orally. The cranial defects were repaired four months later. Ten months after the operation, he was still not vocalising although CNS assessmen