Nail through skull into brain
Suicide attempt with nail gun.
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The nail enters the right squamous temporal bone, just posterior to the sphenosquamous suture. No associated skull fracture. It passes through the right temporal and inferior right frontal lobes, with the tip lying in the midline of the third ventricle. There is beam hardening artefact around the nail. With that limitation, no acute intracranial hemorrhage. No pneumocephalus. No shift in midline structures. The ventricles and CSF spaces are normal.
CT Angiogram: The nail passes just above and anterior to the M2 branch of the right MCA. No arterial injury identified, within the limits of this study. The remainder of the circle of Willis, the carotid arteries, and the vertebral arteries opacify normally.
Despite enormous improvements in reducing artefact form implanted metal (such as aneurysm clips or orthopedic plates and screws) non-medical steel still causes significant image degradation making the assessment of adjacent tissues difficult. In this instance, the CTA is nonetheless able to exclude adjacent large vessel injury.
This individual (images obtained from another institution many many months ago) had the nail removed and made a good clinical recovery.