Nail impalement brain injury in a tertiary healthcare facility in Ghana: A case report and review of pertinent literature

Penetrating injuries to the brain are rare and have a mortality rate of 40% if they are high velocity. They could occur accidentally or intentionally from suicidal or homicidal attempts. Impalement head injuries could be complicated by intracranial hemorrhage, neurological deficits, infection, and epilepsy but usually have good prognosis. A craniotomy is the preferred surgical intervention for such injuries. A 20-year-old male with bipolar disorder presented to a primary-care facility with a nail at the vertex of the head, presumed to be self-inflicted, and was referred to Tamale Teaching Hospital. The GCS was 14/15 with no focal neurological deficits. All other examinations remained normal. A skull x-ray and head computed tomography (CT) scan revealed the position of the nail and aided in diagnosis. A delayed mini craniectomy was performed on the 11th day of admission and the nail was successfully removed with no complications. Nail impalement brain injury is a complex injury whose management can pose challenges to the neurosurgeon in a low-resource center.