Limits...
Penetrating intracranial nail-gun injury to the middle cerebral artery: A successful primary repair.

Isaacs AM, Yuh SJ, Hurlbert RJ, Mitha AP - Surg Neurol Int (2015)

Bottom Line: Initial imaging revealed that the nail had penetrated the cranium and suggested the vasculature to be intact.However, due to the proximity of the nail to the circle of Willis the operative approach was tailored in anticipation of a vascular injury.Intraoperatively removal of the foreign body demonstrated a laceration to the M1 branch of the middle cerebral artery (MCA), which was successfully repaired.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.

ABSTRACT

Background: Penetrating nail-gun injuries to the head are rare, however, the incidence has been gradually rising over the last decade. While there is a large volume of case reports in the literature, there are only a few incidences of cerebrovascular injury. We present a case of a patient with a nail-gun injury to the brain, which compromised the cerebral vasculature. In this article, we present the case, incidence, pathology, and a brief literature review of penetrating nail-gun injuries to highlight the principles of management pertaining to penetration of cerebrovascular structures.

Case description: A 26-year-old male presented with a penetrating nail-gun injury to his head. There were no neurological deficits. Initial imaging revealed that the nail had penetrated the cranium and suggested the vasculature to be intact. However, due to the proximity of the nail to the circle of Willis the operative approach was tailored in anticipation of a vascular injury. Intraoperatively removal of the foreign body demonstrated a laceration to the M1 branch of the middle cerebral artery (MCA), which was successfully repaired.

Conclusion: To our knowledge, this is the first reported case of a vascular arterial injury to the MCA from a nail-gun injury. It is imperative to have a high clinical suspicion for cerebrovascular compromise in penetrating nail-gun injuries even when conventional imaging suggests otherwise.

No MeSH data available.


Related in: MedlinePlus

Anterior-Posterior and lateral skull X-rays showing an 8.7 cm nail projecting over the right temporal region, with apparent intracranial extension. No discrete calvarial fractures are detected
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4596057&req=5

Figure 1: Anterior-Posterior and lateral skull X-rays showing an 8.7 cm nail projecting over the right temporal region, with apparent intracranial extension. No discrete calvarial fractures are detected

Mentions: A 26-year-old male with no prior medical illnesses presented to hospital after apparently accidentally shooting himself with a nail-gun. He reportedly tripped while helping a friend with work on a deck, triggering the nail-gun during the fall. The patient denied any loss of consciousness, headaches, or seizure-like activity. He was initially assessed in a peripheral hospital Emergency Department where plain skull X-rays revealed a nail traversing the temporal bone [Figure 1]. Subsequently, he was transferred to our neurosurgical service for further evaluation and management.


Penetrating intracranial nail-gun injury to the middle cerebral artery: A successful primary repair.

Isaacs AM, Yuh SJ, Hurlbert RJ, Mitha AP - Surg Neurol Int (2015)

Anterior-Posterior and lateral skull X-rays showing an 8.7 cm nail projecting over the right temporal region, with apparent intracranial extension. No discrete calvarial fractures are detected
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596057&req=5

Figure 1: Anterior-Posterior and lateral skull X-rays showing an 8.7 cm nail projecting over the right temporal region, with apparent intracranial extension. No discrete calvarial fractures are detected
Mentions: A 26-year-old male with no prior medical illnesses presented to hospital after apparently accidentally shooting himself with a nail-gun. He reportedly tripped while helping a friend with work on a deck, triggering the nail-gun during the fall. The patient denied any loss of consciousness, headaches, or seizure-like activity. He was initially assessed in a peripheral hospital Emergency Department where plain skull X-rays revealed a nail traversing the temporal bone [Figure 1]. Subsequently, he was transferred to our neurosurgical service for further evaluation and management.

Bottom Line: Initial imaging revealed that the nail had penetrated the cranium and suggested the vasculature to be intact.However, due to the proximity of the nail to the circle of Willis the operative approach was tailored in anticipation of a vascular injury.Intraoperatively removal of the foreign body demonstrated a laceration to the M1 branch of the middle cerebral artery (MCA), which was successfully repaired.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.

ABSTRACT

Background: Penetrating nail-gun injuries to the head are rare, however, the incidence has been gradually rising over the last decade. While there is a large volume of case reports in the literature, there are only a few incidences of cerebrovascular injury. We present a case of a patient with a nail-gun injury to the brain, which compromised the cerebral vasculature. In this article, we present the case, incidence, pathology, and a brief literature review of penetrating nail-gun injuries to highlight the principles of management pertaining to penetration of cerebrovascular structures.

Case description: A 26-year-old male presented with a penetrating nail-gun injury to his head. There were no neurological deficits. Initial imaging revealed that the nail had penetrated the cranium and suggested the vasculature to be intact. However, due to the proximity of the nail to the circle of Willis the operative approach was tailored in anticipation of a vascular injury. Intraoperatively removal of the foreign body demonstrated a laceration to the M1 branch of the middle cerebral artery (MCA), which was successfully repaired.

Conclusion: To our knowledge, this is the first reported case of a vascular arterial injury to the MCA from a nail-gun injury. It is imperative to have a high clinical suspicion for cerebrovascular compromise in penetrating nail-gun injuries even when conventional imaging suggests otherwise.

No MeSH data available.


Related in: MedlinePlus