Neuroimaging Cases 007

Penetrating head trauma

Over the past two years we have created six neuroimaging presentations which we will continue to add to. However, today we present the first in our Neuroimaging Case Studies Series in which we share a clinical case, brief literature review, and concise summary recommendations.

Images, text and cases collated by Teresa Crow MD, Troy Carnwath MD, Scott DiMeo MD, L. Erin Miller MD and Natalie Rall MD. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs.

Summary

• Most nail gun injury victims are male; nearly 50% are self-inflicted
• After assessment and stabilization, a CT/CT-A should be performed
• The initial injury management strategy is otherwise unchanged
• Definitive neurosurgical interventions will be based on the patient’s clinical status and anatomic injury burden
• First week: tetanus + antibiotics + seizure prophylaxis
• Long-term anticonvulsant therapy if any nails are left in place
• Most patients who are alert on presentation recover well

References

• Woodall MN, Alleyne CH Jr. Nail-gun head trauma: A comprehensive review of the literature. J Trauma Acute Care Surg. 2012 Oct;73(4):993-6.
• Yuh SJ, Alaqeel A. Ten self-inflicted intracranial penetrating nail gun injuries. Neurosciences (Riyadh). 2015 Jul;20(3):267-70.
• Kow CY, Hakim JS, Aspoas AR, Brew S, McGuinness B, Correia J. Nailed Through Superior Sagittal Sinus: A Case Report and Surgical Considerations. Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):e223-e227. 
• Hoey A, Troy C, Bauerle W, Xia A, Hoey B. Delayed-Onset Seizures Following Self-Inflicted Nail Gun Injury to the Head: A Case Report and Literature Review. J Neurol Surg Rep. 2022 Jun 24;83(2):e54-e62.

This neuroimaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.