Case Report

Multiple Self-inflicted Nail Gun Head Injury

Authors: George M. Testerman, MD, Laura M. Dacks, MD

Abstract

Penetrating brain injury resulting from nail-gun use is a well-characterized entity, one that is increasing in frequency as nail guns become more powerful and more readily available to the public. We present a case and offer management strategies for a 50-year-old male with two intracranial penetrating nail gun injuries. Nail gun brain injuries are commonly intentionally self-inflicted. Suicide should be considered when straight nails cause wounds to the chest, head, or abdomen. The primary preoperative concern is formation of a traumatic pseudoaneurism, which prompts both preoperative and follow-up cerebral angiography. Surgery for combined intracranial and extracranial injury may require the collaborative expertise of colleagues from the fields of ophthalmology, otolaryngology, and oral maxillofacial surgery. A rational management strategy should permit these patients to be discharged with no additional injury.


Key Points


* Nail gun injuries are increasingly reported in construction accidents.


* Nail gun brain injuries are commonly intentionally self-inflicted.


* Careful preoperative and postoperative strategies including liberal use of cerebral angiography to rule out cerebrovascular injuries are recommended.

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