Management of a nail impalement injury to the brain in a non-neurosurgical centre: A case report and review of the literature

• This nail impalement injury to the brain was self-inflicted by a mentally challenged person who presented in a non-neurosurgical centre.
• After clinical assessment and limited investigations, a burr hole adjoining the nail was made by the orthopaedic team to loosen the nail and to carry out a successful extraction.
• The patient’s headache resolved swiftly and his limb weakness recovered fully by four months.

A nail impalement injury to the brain usually results from accidents like falls or nail gun miss-fires or suicide attempts or from barbaric punishment for certain crimes which are rarely practiced in some remote areas. We present an unusual, intentional, self-impalement of a 4 in. nail into the brain in a mentally challenged young man. This case report describes the challenges encountered in the management of a patient with impaled nail in the brain in a non-neurosurgical centre.