Penetrating Cranial Nail Injury an Unusual Domestic Assault: Case Report

A rare case of intracranial nail injury caused by domestic violence is presented. The 35-year old female patient was found unconscious with a 12cm nail almost completely buried into her skull. X-ray of the skull showed the nail in the cranial cavity. A burr hole was made and the nail removed. Immediate post-operative period showed a Glasgow coma score of 10/15 and right hemi paresis which improved with time. At six month after the injury, her neurological status was normal. Despite the lack of a CT scan in some areas attempt must be made using clinical judgment and performance of burr holes to treat such patients who cannot afford transfer to a standard neurological centre. This report also highlights the fact that penetrating brain injuries of this nature can occur without much neurological deficit and that a minimally invasive surgical approach can be used successfully to manage such cases while avoiding serious postoperative complications.