Intracranial needle insertion into an infant's brain: a case report revealing an unprecedented computed tomography discovery.

Intracranial needling is an exceptionally rare phenomenon, with approximately 40 cases described in the literature globally. We report the first known case in South Africa involving a three-month-old infant, whose brain imaging revealed six intracranial needles. The infant, who has been hospitalised his entire life and was already critically ill with sepsis and known congenital anomalies, underwent a computed tomography (CT) scan after developing focal seizures, which incidentally detected the foreign bodies. Post-mortem examination confirmed six hollow needles embedded within the brain, introduced via the fontanelles. Histopathological analysis revealed chronic reactive gliosis and chronic subdural haematoma, indicating survival for a period following insertion. The cause of death was attributed to overwhelming sepsis rather than needle injury. Advanced imaging techniques, including 3D volume-rendered reconstructions and stereoscopic imaging, were crucial for assessing the number, location, and trajectory of the needles, enhancing autopsy planning and forensic documentation. This case highlights the critical role of post-mortem CT imaging in detecting covert injuries, especially in vulnerable populations, and underscores the necessity of routine PMCT in unexplained infant deaths. Without imaging, grievous assault may have remained undiscovered. The findings also demonstrate the forensic advantages of advanced imaging techniques for medico-legal investigations and courtroom presentations.