A Nail in the Brain

Area of Science:

• Neurosurgery
• Ophthalmology
• Occupational Health

Background:

• Transorbital penetrating brain injuries (TOPI) are uncommon, often resulting from high-velocity impacts.
• Industrial accidents involving tools like nail guns pose significant risks for severe head and eye trauma.

Observation:

• A 30-year-old male sustained a perforating left eye injury and intracranial foreign body from an accidental nail gun discharge at a construction site.
• The nail penetrated the orbit, lodging in the frontal lobe, and caused orbital fractures and lacerations.

Findings:

• Emergency bicoronal craniotomy successfully removed the intracranial nail.
• The patient achieved a full neurological recovery (Glasgow Coma Scale 15) and was discharged on postoperative day 5.
• Despite successful surgical intervention, the patient experienced complete vision loss (no perception of light) in the affected left eye.

Implications:

• This case underscores the severe consequences of work-related penetrating eye injuries.
• Emphasizes the critical importance of stringent safety protocols and equipment maintenance in industrial settings to prevent such debilitating injuries.
• Highlights the potential for significant visual morbidity even with successful neurosurgical management of intracranial foreign bodies.