A Nail in the Brain

TL;DR

A man suffered a rare brain injury when a nail gun misfired into his eye during work, requiring surgery to remove the nail from his brain.

Contribution

This case report highlights a rare industrial injury involving a nail gun causing a transorbital penetrating brain injury.

Findings

The nail was successfully removed from the frontal lobe with no neurological deficits.

The patient retained no perception of light in the affected eye.

The injury underscores the preventable nature of work-related eye injuries.

Abstract

Transorbital penetrating brain injuries (TOPI) are rare. We report a case of industrial injury that resulted in perforating eye injury and intracranial foreign body by a nail gun. A 30-year-old man accidentally fired a nail gun onto his left eye at his construction workplace while handling the malfunctioned equipment and sustained a perforating injury of the left eye with intracranial foreign body. The misfired nail was lodged in his frontal lobe of the brain. He also suffered laceration wounds of the lateral canthus of the left eye and fractures of the left orbital floor and roof. He underwent emergency bicoronal craniotomy and removal of intracranial foreign body, followed by left eye examination under anaesthesia as well as scleral toilet and suturing. The nail was successfully removed. He recovered well with no neurological deficit and was discharged on postoperative day 5 with a Glasgow Coma Scale score of 15; however, his left eye vision remained no perception of light. Work-related eye injuries can be debilitating and are largely preventable.

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