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Abstract
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Penetrating brain injury(PBI) caused by a nail gun is a highly uncommon neurosurgical emergency, presenting a significant challenge for neurosurgeons due to its rarity and complexity.1 This article presents a case study on the occurrence of PBI resulting from a nail gun, and subsequently discusses the treatment principles pertaining to high velocity craniocerebral penetrating injuries.
A 54-year-old man was engaged in construction work when a nail gun malfunctioned, causing a foreign object to penetrate the skull. Upon sustaining the injury, the patient lost consciousness and was subsequently transported to the emergency department of the nearby county hospital. A computed tomography(CT) scan of the head revealed the presence of a subdural hematoma in the left frontal and temporoparietal regions, as well as a contusion with hematoma in the left temporal lobe, along with evident compression of the brain stem (Fig. 1A, Fig. 1B, Fig. 1C A,B,C). Upon being informed of the necessity for craniotomy, the patient's family expressed their desire for the patient to be transferred to our medical facility. Prior to arrival, the patient had undergone tracheal intubation assisted ventilation. Notably, a nail entrance was observed on the face, with the nail tip visible on the posterior occipital region (Fig. 1D). Furthermore, the patient exhibited a Glasgow Coma Scale score of 5 (E1 V1 M3). A repeat Head CT examination was conducted promptly upon the patient's arrival at our hospital. Although there was no observed increase in intracranial hematoma, the severity of brain swelling was notable. During the process of improving preoperative preparations, the patient exhibited bilateral pupil dilation of approximately 0.7 cm, loss of light reflex, and cessation of spontaneous respiration. We conveyed to the patient's family that the prognosis was exceedingly unfavorable, which ultimately resulted in their decision to reject the surgical intervention. Tragically, the patient succumbed to their condition two days thereafter. To comprehend the etiology of the patient's injury, we conducted an investigation at his construction site, procured pertinent data regarding the nail gun (Fig. 1E), and acquired knowledge pertaining to the trigger mechanism employed by said nail gun.
Language: en |