Post-traumatic cerebral myiasis: the first case report in Ghana and implications for neurotrauma care in low-resource settings.

Introduction and importance: Cerebral myiasis is a rare neurosurgical condition with only 21 cases reported globally. Post-traumatic forms are common in low- to middle-income countries, often arising from neglected wounds. We report the first documented case in Ghana, highlighting systemic barriers to timely neurotrauma care. Case presentation: A 7-year-old boy sustained an open comminuted skull fracture as an unhelmeted pillion rider in a tricycle collision. After a 3-day delay in wound care at a peripheral facility, he presented with a foul-smelling, sand-contaminated wound. Neurologic assessment revealed GCS 4/15, anisocoria, flaccid paralysis of all limbs, and absent plantar reflexes. The 12 × 8 cm wound overlaid the right frontal lobe with exposed brain tissue and several maggots were observed around the wound. Ten larvae were removed from wound, extensive debridement was performed, and broad-spectrum antibiotics were initiated. Despite intensive multidisciplinary care, the patient died on day 5 of admission. Clinical Discussion: While head injury of such severity requires immediate multidisciplinary care in an intensive unit, there was a lag in assessing referral centers. This was compounded by a lack of expertise in wound management and the absence of appropriate remote guidance from experts. This case highlights challenges in neurotrauma care in Ghana amidst limited and highly centralized specialist facilities. Conclusion: Post-traumatic cerebral myiasis within a hospital is a testament to weak trauma care. It emphasizes the urgent need to implement measures, such as telemedicine support for peripheral centers, improved trauma referral pathways, and capacity building in emergency stabilization.