Self-inflicted nail-gun injury with 12 cranial penetrations and associated cerebral trauma

Abstract

In this case report, the authors describe a 33-year-old man who presented with headache due to the presence of 12 nail-gun nails impacted in his cranium and cerebral parenchyma. The authors also review the relevant literature regarding penetrating brain injury. The patient's physical examination revealed a Glasgow Coma Scale score of 15 and impairment of abduction of the right eye and abduction of the jaw producing dysarthria; the remaining results of the neurological examination were normal. Both x-ray films and computerized tomography (CT) scans of the head revealed the presence of 12 nails, the majority of which were located intracranially. A scattering artifact limited the ability of CT scanning to demonstrate any intracranial hemorrhage. Angiography did not demonstrate any evidence of traumatic vascular injury. After general anesthesia had been induced in the patient, the nails were removed in the operating room. Following removal of the final nail, a small left temporal craniotomy was performed to control hemorrhage from a tear in the left middle meningeal artery. Despite the development of a postoperative insular hematoma, the patient was discharged home with minimal deficits. This patient is the only known survivor of the largest number of foreign objects (12) to penetrate the skull intentionally. Overall, self-inflicted nail-gun injuries are less common than accidental discharges. A review of the literature, however, suggests that for penetrating brain injury, self-infliction is the more common mechanism. For those patients who survive such an injury, clinical decision making must focus on preventing further cortical or vascular damage. A rational management strategy should permit these patients to be discharged with no additional injury.

A Rare History: an Intracranial Nail Present for Over a Half-Century

“…The complications can range from intracerebral hematoma, intraventricular hemorrhage, cerebral contusion, pneumocephalus, brain stem injury and carotid sinus fistula, amongst others (5-7). Injuries to the intracerebral vasculature and infections are the major cause of death (8)(9)(10). Our case is interesting because the patient lived more than half of a century with a nail in her brain with persistent headaches being the only symptom.…”

Penetrating head trauma with four nails: an extremely rare case

“…Injuries that occur in psychiatric disorders constitute 66.7%, and are usually inflicted upon another individual by the person with the psychiatric disorder. [6] This condition has been observed frequently especially in schizophrenia and major depressive disorder. [1][2][3][4][5] Intracerebral hematoma is one of the most important causes of mortality in strongly penetrant head traumas such as those caused by nails.…”

“…[1][2][3][4][5] Penetrating head traumas caused by nails are usually inflicted upon others. [6] Our case is interesting since the penetrating head trauma with nails was selfinflicted.…”

Management of Non-Missile Penetrating Brain Injuries: A Description of Three Cases and Review of the Literature

“…27 Traumatic aneurysms may occur in a delayed fashion and carry a 50% mortality rate if left untreated. [26][27][28][29] Not all these lesions are visible on initial angiography and therefore a second angiogram should be performed 2 to 3 weeks later in all patients with penetrating brain injuries. Our third case exemplifies this phenomenon.…”