Traumatic brain injury caused by Brazil-nut fruit in the Amazon: A case series

Background: Traumatic brain injury (TBI) represents one of the leading public health problems and a significant cause of neurological damage. Unintentional causes of TBI are the most frequent. However, fruit falling over the head causing TBI is extremely rare. In the Amazon region, accidents with ouriços, a coconut-like shell fruit, seem relatively common. However, to the best our knowledge, it has never been described in a scientific journal before. Therefore, we aim to evaluate a series of TBI caused by this tropical fruit. Methods: This study is a retrospective review of 7 TBI cases due to the fall of ouriços admitted to two tertiary hospitals in the Amazon region from January 2017 to December 2018. The collected data included: age, Glasgow Coma Scale, skull fracture, venous sinus injury, hematoma, surgical treatment, and outcome. Results: All patients were men, with an average age of 38, ranging from 8 to 77-years-old. Four out of seven had skull fractures. Five patients developed an epidural hematoma, and two of them had an associated subdural hematoma. Dura mater injury was observed in two patients, whereas four patients were operated. There was one related death. Conclusion: This case series is the first to describe an unconventional but potentially fatal cause of TBI in the Amazon: the falling of the Brazil-nut fruit. Most patients were diagnosed with mild TBI. Nevertheless, patients may have cranial fractures and epidural hematomas, leading to death when there’s a delay in medical assistance.

[1]  Maria Clara Paulino Campos,et al.  Management of traumatic brain injury at a medium complexity hospital in a remote area of Amazonas, 2017-2019. , 2020, World neurosurgery.

[2]  A. Santos,et al.  Neurological trauma profile of traffic accident victims patients in a rehabilitation center / Perfil do trauma neurológico em pacientes vítimas de acidentes de trânsito em um centro de reabilitação / Perfil trauma neurológico en accidentes de tráfico víctimas pacientes.. , 2018 .

[3]  H. Steiger,et al.  Pharmacological targeting of secondary brain damage following ischemic or hemorrhagic stroke, traumatic brain injury, and bacterial meningitis - a systematic review and meta-analysis , 2017, BMC Neurology.

[4]  L. Battirola,et al.  The Brazil nut tree (Bertholletia excelsa Humb. & Bonpl. (Lecythidaceae)): Importance and biological interactions , 2017 .

[5]  Likang Xu,et al.  Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013 , 2017, Morbidity and mortality weekly report. Surveillance summaries.

[6]  R. Franklin,et al.  Unintentional injury prevention and the role of occupational therapy in the Solomon Islands: an integrative review. , 2016, Rural and remote health.

[7]  H. Eid,et al.  Injuries from falling objects in the United Arab Emirates , 2015, International journal of injury control and safety promotion.

[8]  Human injury model for small unmanned aircraft impacts , 2014 .

[9]  Talita Guerra Gaudêncio,et al.  A Epidemiologia do Traumatismo Crânio-Encefálico: Um Levantamento Bibliográfico no Brasil , 2013 .

[10]  Raimundo Nonato Ribeiro Fernandes,et al.  Epidemiology of traumatic brain injury in Brazil , 2013, Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery.

[11]  W. Paiva,et al.  Management of supratentorial epidural hematoma in children: report on 49 patients. , 2010, Arquivos de neuro-psiquiatria.

[12]  Jun Yang Brazil nuts and associated health benefits: A review , 2009 .

[13]  Cynthia Bir,et al.  Tolerance of the skull to blunt ballistic temporo-parietal impact. , 2009, Journal of biomechanics.

[14]  Evandro T. Martins,et al.  Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City. , 2009, The Journal of trauma.

[15]  J. Langlois,et al.  Incidence of Traumatic Brain Injury in the United States, 2003 , 2006, The Journal of head trauma rehabilitation.

[16]  Ricardo Silva,et al.  Características dos pacientes com trauma cranioencefálico na cidade do Salvador, Bahia, Brasil , 2004 .

[17]  W Goldsmith,et al.  Biomechanics and neuropathology of adult and paediatric head injury , 2002, British journal of neurosurgery.

[18]  Escoffery Ct,et al.  Fatal head trauma from tree related injuries. , 2001 .

[19]  H. Oberli,et al.  Coconut palm‐related injuries in the pacific islands , 2001, ANZ journal of surgery.

[20]  P. Barss,et al.  Falls from trees and tree associated injuries in rural Melanesians. , 1984, British medical journal.

[21]  P. Barss Injuries due to falling coconuts. , 1984, The Journal of trauma.