Intracranial needles since 14 year: diagnostic challenges and management strategies - a case report and literature review.

Background and importance: Intracranial foreign bodies are rare and mostly found accidentally. These are associated with penetrating trauma or the result of surgical interventions. However, this deliberate introduction of objects like needles during infancy as an attempted infanticide is very rare. Reported cases suggest that such objects can remain asymptomatic for years or present later with seizures, neurological deficits, or sometimes with infections. Studies indicate that the management varies from conservative follow-up to surgical removal, depending on symptoms and associated complications. Infections such as brain abscesses have been reported, necessitating antibiotic therapy in some cases, while others remain neurologically intact despite the foreign body for a very long time. Case presentation: We report the case of a 14-year-old girl who presented with intermittent frontal headaches. Her Neurological examination was unremarkable. An X-ray skull was performed, which showed two linear intracranial foreign bodies near the anterior fontanelle, which was followed by a CT-brain, which also confirmed two intracranial foreign bodies. Due to the absence of acute complications, this patient was managed conservatively with symptomatic treatment for her headaches and regular follow-ups to monitor for potential neurological or infectious complications. Clinical discussion: This case highlights the clinical and social implications of retained intracranial foreign bodies resulting from very sinister acts of child abuse. The delayed presentation underscores the importance of advanced imaging in diagnosis and management. The literature supports conservative management in asymptomatic patients unless complications arise. Conclusion: This case emphasizes the need for multidisciplinary care, including medical, psychological, and forensic support. Raising awareness and strengthening child protection systems are crucial to preventing such tragic outcomes rooted in sociocultural practices.