Multiple brain metallic foreign bodies

Case contributed by Dr Bruno Di Muzio

Presentation

Schizophrenic patient injured himself with a nail gun.

Patient Data

Age: 45 years
Gender: Male
CT

CT and CTA Brain

Multiple metallic foreign bodies consistent with nails that have been placed through the lateral aspects of the skull, none of them cause evident vascular injury to the major intracranial vessels. 

CT

CT Brain (after surgery)

There has been interval removal of the multiple nails penetrating the calvaria. Linear foci of hyperdense blood in both frontal lobes are consistent with haemorrhagic contusions along the tracts of the nails penetrating these regions. There is stable diffuse subarachnoid blood. No extra-axial collection or other new foci of intracranial haemorrhage. A few tiny locules of pneumocephalus overlie the left frontal lobe. A small fleck of bone fragment is again noted in the left temporal lobe. Normal grey-white matter differentiation is maintained. No intraorbital postseptal haematoma identified.

Case Discussion

Multiple self-inflicted brain metallic foreign bodies which luckily did not injure the circle of Willis. The nails were removed without an intracranial approach with further conservative management. The patient has recovered well within a week. 

These injuries are considered within the group/mechanism of the low-velocity penetrating brain injuries as they are not associated with diffuse axonal injuries, cavitation, and shock waves usually seen in gunshot projectiles. The injury is commonly seen only along the nail track 1.

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Case information

rID: 54443
Published: 10th Mar 2018
Last edited: 28th Jun 2018
Inclusion in quiz mode: Excluded

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