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 20-year old male presented to the Emergency Department having been accidentally shot in the neck, by a friend using a 0.22 calibre air rifle, at a distance of approximately three metres. He complained of neck stiffness and pain on swallowing. Examination revealed an entry wound 1 cm below the level of the thyroid notch to the left of the midline, figure . A tense, non-pulsatile haematoma was evident deep to the entry wound. No bleeding or surgical emphysema were present. His voice was hoarse, although flexible endoscopic examination showed no pharyngeal or laryngeal abnormality. Cervical spine radiographs demonstrated an airgun pellet antero-lateral to the transverse process of C6, with a surrounding 6 cm diameter radiopacity consistent with haematoma and no deviation of the trachea, figure .\nPrimary resuscitation was uneventful, and the patient was taken to theatre within four hours for exploration of the wound and evacuation of the haematoma. Upon evacuation of the haematoma extensive haemorrhage developed from a defect in the anterior wall of the external carotid artery, which required rapid access and surgical repair. The airgun pellet was localised using image intensification and successfully retrieved from the paraspinous muscles, figure .\nThe pellet tract traversed the left lobe of the thyroid gland and the carotid sheath, impacting on the antero-medial aspect of the external carotid artery, just above the bifurcation, figure . It further traversed the paraspinous muscles and embedded immediately anterior to the transverse process of the sixth cervical vertebrae, at a depth of 8 cm from the skin entry wound.\nInitial recovery was uneventful, however at follow-up it was clear that the patient had Horner's syndrome from injury to the left cervical sympathetic chain and carotid arteries.