A 31-year-old white male presented with a progressive spastic quadriparesis over 1-year duration. Four years previously, he had fallen from a horse into a tree called Mandacaru (Cereus jamaracu) in northeast Brazil. At the time of the injury, the patient had several skin wounds but no neurological symptoms or signs. Four years later, he presented with new onset of spastic tetraparesis characterized by motor 4/5 strength in the upper and lower limbs; he could only ambulate with assistance.\nWhile plain radiographs of cervical spine revealed upper cervical kyphosis, computed tomography (CT) scan [] demonstrated a foreign body resembling a needle that entered the spinal canal through the left C3-C4 foramen. Magnetic resonance imaging (MRI) [] demonstrated extensive edema in the cervical spinal cord and enhancement with gadolinium of tissue surrounding the foreign body.\nThe needle was removed utilizing a left side approach to the left C3-C4 foramen. (Hodgson-like approach[] posterior-lateral view).\nA 5-cm thorn was removed []; of interest, there was no cerebrospinal fluid (CSF) leak. The postoperative course was uneventful and he continued to improve over the next 6 months.
A 58-year-old Iranian man presented to our emergency department after an air gun shot injury. On admission, a penetrating wound in the left lateral region of zone II of his neck was detected. His vital signs were normal. His only complaint was slight odynophagia. No bleeding, hematoma, dysphonia or subcutaneous emphysema was noticeable. On further investigation, anteroposterior and lateral X-rays showed a hyperdense pellet in the left latera region of his neck (Figure ). A computed tomography scan confirmed the presence of the pellet at the level of the thyroid cartilage (Figure ).\nOur patient underwent a neck exploration using a hockey stick incision. After the primary incision of the skin and platysma, the carotid sheath was explored with no findings of note. An intraoperative X-ray of his neck, using control needle markers, revealed a tiny orifice of about 1.5mm on the left superior part of the thyroid cartilage. Extending the orifice to 1.5cm showed a pellet between the cartilage and the lining mucosa (Figure ). The pellet was removed. After complete repair of the cartilage and placing a drain, the subcutaneous tissue and skin were repaired.\nOur patient was discharged after drain removal with good general health. On a two-year follow-up he did not report any problem or complication and his physical examination remained normal.