Nail impalement injury
This article highlights the case of an unidentified who lived with a nail injury in his head for 12 years. The patient presented to the emergency department with right-sided facial droop. Examination showed diminished sensibility, intoxication and signs of mild hemiparesis. The patient’s hemiparesis persisted even after he became sober and fully articulate. Doctors advised a computed tomographic scan of the head which showed a nail in the brain. 9 hours after his admission, the patient revealed that he tried to commit suicide 12 years ago because of a depressive episode. He tried to kill himself with a nail gun directed between his eyes. The patient has been completely symptom-free since the attempt with no seizures or loss of consciousness.
Nail injuries can be caused because of accidental falls and bomb blasts
Nail implement injury to the brain is commonly caused because of an accidental fall into shrapnel. It is rarely a neurosurgical emergency. In several cases, misfiring of a nail gun during construction work can also cause the injury. However, in this case the impalement of the nail is intentional. Several studies have reported the impalement of a nail to the brain in an attempt of suicide in mentally challenged persons. Bomb blasts can also lead to nail pieces being driven into the brain from explosive devices.
Most patients with nail impalement injuries have a good prognosis except for bomb blast injuries. This is mainly the case with low velocity injuries. The nail can successfully be surgically extracted, especially in cases where the nail head is secured. However, blind removal is highly discouraged because of a risk of brain injury. The management of nail impalement surgery comes with several challenges, especially in poor resource settings. However, it can be restored successfully if the nail head is secured.
Source: NEJM
