Knife Through Eye and Brain: Surgeons Remove Blade, Patient Recovers Well

A man in his 20s walked into a hospital in the United Kingdom with the handle of a knife protruding from his face. Hidden inside was a blade 15 millimeters wide. It had gone straight through his right eye and on through his brain, and its tip had come to rest against the top of his skull.

He was alive and conscious on arrival. He could speak and move all four limbs, though his doctors described him as agitated. On the Glasgow Coma Scale he scored 12, which signals a moderate brain injury and sits one point above mild. The score broke down as E3, V4 and M5: he opened his left eye when told to but otherwise kept it shut, he answered questions but was confused, and he deliberately moved away when pressure was applied to his body.

The team feared that, confused and agitated, he might try to yank the knife out himself. They sedated him and put in a breathing tube quickly. They also started preventive treatment against bacterial infection, tetanus included, and then turned to imaging to learn what the blade had done. The doctors reported the case in BMJ Case Reports, published on a Friday.

The scans showed the blade passing completely through the right eye socket and eyeball, then crossing the left frontal and temporal lobes. It went in front of the corpus callosum, the nerve-fiber bridge between the brain's two halves, and apparently did not injure it. It also missed the left internal capsule, another bundle of nerve fibers. The blade lay close to the left internal carotid artery, a major vessel, but did not appear to have damaged it. A branch of the middle cerebral artery did look indented by the knife.

After consulting several specialties, the doctors took him to emergency neurosurgery. They removed part of the skull so they could see into the brain directly, but chose a conservative approach they call "pull-and-see," sliding the blade out rather than digging it free. Once it was out, they saw no sign of significant bleeding. They cleaned and drained the wound in the brain and repaired the skull. The right eye, badly damaged, could not be saved and was removed.

He went to intensive care and recovered rapidly. The breathing tube came out a day after surgery. Some mild weakness on his right side appeared and resolved two days later. Brain scans showed steady improvement, with a little bleeding and swelling and some air in the tissue along the knife's path, but otherwise healing. He had no infections and no seizures. His language function was intact, and he lost no movement or coordination. He was discharged and, at follow-up visits, remained neurologically well, with eye and mental health care continuing.

How the injury happened is not known; the authors wrote that the mechanism is unclear. They noted that he had a history of depression. Injuries that pass through the eye and brain are rare, and usually come from high-velocity causes such as gunshots. Knives, rods and nails fall into the low-velocity category, which the doctors say carries substantial illness and death from hemorrhage, vascular injury, abscess, meningitis, cerebrospinal fluid leak, seizures and neurological deficit.

Unexpected recoveries have precedent. The authors cited Phineas Gage, the railroad foreman who survived an 1848 accident in which an iron rod entered below his left cheekbone and exited the top of his skull. Gage's personality was said to have changed afterward; the doctors in this case did not mention any such change. They also pointed to a reported nail-gun injury. Their conclusion was that outcome may depend less on outward severity than on the precise path relative to critical vessels and brain structures.