{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:38:54Z","timestamp":1791261534886,"version":"4.1.0"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,6,16]]},"abstract":"\n BACKGROUND<\/jats:title>\n Intracranial nail impalement injury is a rare type of low-energy penetrating brain injury resulting from the forceful entry of a nail into the cranial cavity without exiting it. Clinical outcome depends on the number of impaling nails, the depth of penetration, the extent of the primary brain injury, associated vascular injury, and prompt surgical management to limit secondary injuries. The authors report a case and the management outcome in a low-middle-income country.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 27-year-old man was reportedly found by his relatives on the floor of his room, having generalized tonic-clonic seizures, and was brought to the University of Uyo Teaching Hospital. He was resuscitated, and an urgent cranial CT scan was performed that showed seven fully implanted, nail-shaped foreign bodies. He underwent emergency craniotomy with extraction of seven 3-inch nails. Brisk bleeding encountered from the injured superior sagittal sinus was controlled effectively. In the postoperative period, he developed nail tracks abscesses that were treated with antibiotics for 6 weeks. He had an excellent recovery with no neurological deficit and was discharged home.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Multiple intracranial nail impalement injuries, although life-threatening, can be treated with excellent outcome following prompt treatment, meticulous surgical technique, and appropriate duration of antibiotics.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25103<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25103","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T20:02:08Z","timestamp":1750104128000},"source":"Crossref","is-referenced-by-count":2,"title":["Management outcome of a patient with a self-inflicted multiple intracranial nail impalement in a tertiary hospital in Uyo: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8761-0068","authenticated-orcid":true,"given":"Ubong U.","family":"Ekpene","sequence":"first","affiliation":[{"name":"Neurosurgery Division, Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ned M.","family":"Ndafia","sequence":"additional","affiliation":[{"name":"Neurosurgery Division, Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enono E.","family":"Uduehe","sequence":"additional","affiliation":[{"name":"Neurosurgery Division, Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nsese","family":"Udeme","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uyi","family":"Usoro","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest J.","family":"Barth\u00e9lemy","sequence":"additional","affiliation":[{"name":"SUNY Downstate Health Sciences University, Division of Neurosurgery, Brooklyn, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Nottidge","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Int J Surg Case Rep","first-page":"115","article-title":"Management of a nail impalement injury to the brain in a non-neurosurgical centre: a case report and review of the literature","volume":"19","author":"Agu","year":"2016","unstructured":"Agu CTOrjiaku ME.Management of a nail impalement injury to the brain in a non-neurosurgical centre: a case report and review of the literature. Int J Surg Case Rep. 2016;19:115-118."},{"issue":"3","key":"bib2","series-title":"Ulus Travma Acil Cerrahi Derg","first-page":"265","article-title":"Penetrating head trauma with four nails: an extremely rare case","volume":"18","author":"Ar\u0131c\u0131","year":"2012","unstructured":"Ar\u0131c\u0131 LAkg\u00fcn BKaplan MY\u0131lmaz I.Penetrating head trauma with four nails: an extremely rare case. Ulus Travma Acil Cerrahi Derg. 2012;18(3):265-267."},{"issue":"14","key":"bib3","series-title":"Diagnostics (Basel)","first-page":"1549","article-title":"Repetitive self-inflicted craniocerebral injury in a patient with antisocial personality disorder","volume":"14","author":"Cucu","year":"2024","unstructured":"Cucu AICostea CFSili\u0219teanu SCRepetitive self-inflicted craniocerebral injury in a patient with antisocial personality disorder. Diagnostics (Basel). 2024;14(14):1549."},{"key":"bib4","series-title":"J Med Case Rep","first-page":"58","article-title":"Nail gun injuries to the head with minimal neurological consequences: a case series","volume":"10","author":"Makoshi","year":"2016","unstructured":"Makoshi ZAlKherayf FDa Silva VLesiuk H.Nail gun injuries to the head with minimal neurological consequences: a case series. J Med Case Rep. 2016;10:58."},{"issue":"12","key":"bib5","series-title":"No Shinkei Geka","first-page":"1209","article-title":"Multiple penetrating head injury by 8 nails: a case report","volume":"37","author":"Ichinose","year":"2009","unstructured":"Ichinose NIkawa FOhbayashi NMitsuhara TAbiko MInagawa T.Multiple penetrating head injury by 8 nails: a case report. No Shinkei Geka. 2009;37(12):1209-1213."},{"issue":"4","key":"bib6","series-title":"Acta Neurol Belg","first-page":"767","article-title":"A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder","volume":"115","author":"Xu","year":"2015","unstructured":"Xu MWen JZhu XChen PWang C.A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder. Acta Neurol Belg. 2015;115(4):767-769."},{"issue":"4","key":"bib7","series-title":"Radiol Case Rep","first-page":"334","article-title":"Double penetration wound: a nail gun injury involving the head and heart","volume":"15","author":"Ye","year":"2020","unstructured":"Ye CNLin MCHuang CL.Double penetration wound: a nail gun injury involving the head and heart. Radiol Case Rep. 2020;15(4):334-338."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"377","article-title":"Thirty-two nails injected into the head: an operative report and review of the literature","volume":"13","author":"Zima","year":"2022","unstructured":"Zima LASrinivasan SBudde BKitagawa R.Thirty-two nails injected into the head: an operative report and review of the literature. Surg Neurol Int. 2022;13:377."},{"key":"bib9","series-title":"NMC Case Rep J","first-page":"279","article-title":"Nail penetration in the superior sagittal sinus: a case report of a nail gun injury","volume":"11","author":"Fujiyama","year":"2024","unstructured":"Fujiyama YNomura SHaji KNail penetration in the superior sagittal sinus: a case report of a nail gun injury. NMC Case Rep J. 2024;11:279-283."},{"issue":"5","key":"bib10","series-title":"J Neurosurg","first-page":"828","article-title":"Self-inflicted nail gun injury with 12 cranial penetrations and associated cerebral trauma: case report and review of the literature","volume":"104","author":"Litvack","year":"2006","unstructured":"Litvack ZNHunt MAWeinstein JSWest GA.Self-inflicted nail gun injury with 12 cranial penetrations and associated cerebral trauma: case report and review of the literature. J Neurosurg. 2006;104(5):828-834."},{"issue":"11","key":"bib11","series-title":"Asian J Surg","first-page":"5365","article-title":"Editor-Intracranial penetrating injury by a nail gun: an unusual case report","volume":"46","author":"Wang","year":"2023","unstructured":"Wang HCheng JLong WWang D.Editor-Intracranial penetrating injury by a nail gun: an unusual case report. 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World Neurosurg. 2018;112:143-147."},{"issue":"7","key":"bib18","series-title":"No Shinkei Geka","first-page":"635","article-title":"A penetrating cranio-facial injury due to a nail-gun accident","volume":"25","author":"Inoha","year":"1997","unstructured":"Inoha SSuzuki SFukui MA penetrating cranio-facial injury due to a nail-gun accident. No Shinkei Geka. 1997;25(7):635-639."},{"issue":"2","key":"bib19","series-title":"J Surg","first-page":"31","article-title":"Cranial impalement of a falling fence spike in a child: a case report","volume":"4","author":"Abdullahi Onimisi","year":"2016","unstructured":"Abdullahi Onimisi J.Cranial impalement of a falling fence spike in a child: a case report. J Surg. 2016;4(2):31."},{"issue":"02\/03","key":"bib20","series-title":"Indian J Neurotrauma","first-page":"62","article-title":"An interesting case of penetrating brain injury by a self-hammered nail","volume":"15","author":"Besra","year":"2018","unstructured":"Besra SKHarsh VMishra PSahay CB.An interesting case of penetrating brain injury by a self-hammered nail. Indian J Neurotrauma. 2018;15(02\/03):62-66."},{"issue":"5","key":"bib21","series-title":"Can J Emerg Med","first-page":"788","article-title":"Bilateral nail gun traumatic brain injury presents as intentional overdose: a case report","volume":"20","author":"Alain","year":"2018","unstructured":"Alain JLavergne PSt-Onge MD\u2019Astous MC\u00f4t\u00e9 S.Bilateral nail gun traumatic brain injury presents as intentional overdose: a case report. Can J Emerg Med. 2018;20(5):788-791."},{"issue":"2","key":"bib22","series-title":"J Trauma","first-page":"E59","article-title":"Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm","volume":"63","author":"Springborg","year":"2007","unstructured":"Springborg JBEskesen VOlsen NVGjerris F.Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm. J Trauma. 2007;63(2):E59-E64."},{"issue":"4371367","key":"bib23","series-title":"Case Rep Neurol Med","article-title":"Management of a low-energy penetrating brain injury caused by a nail","volume":"2016","author":"Ferraz","year":"2016","unstructured":"Ferraz VRAguiar GBVitorino-Araujo JLBadke GLVeiga JCE.Management of a low-energy penetrating brain injury caused by a nail. Case Rep Neurol Med. 2016;2016:4371367."},{"issue":"4","key":"bib24","series-title":"Surg Neurol","first-page":"368","article-title":"Double concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note","volume":"64","author":"Spennato","year":"2005","unstructured":"Spennato PBocchetti AMirone GDouble concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note. Surg Neurol. 2005;64(4):368-371."},{"issue":"2","key":"bib25","series-title":"J Digit Imaging","first-page":"362","article-title":"Wearable mixed-reality holographic navigation guiding the management of penetrating intracranial injury caused by a nail","volume":"34","author":"Li","year":"2021","unstructured":"Li YHuang JHuang TWearable mixed-reality holographic navigation guiding the management of penetrating intracranial injury caused by a nail. J Digit Imaging. 2021;34(2):362-366."},{"issue":"3","key":"bib26","series-title":"Br J Neurosurg","first-page":"448","article-title":"Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note","volume":"37","author":"Nussbaum","year":"2023","unstructured":"Nussbaum ESGraupman PPatel PD.Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note. Br J Neurosurg. 2023;37(3):448-452."},{"issue":"2","key":"bib27","series-title":"J Neurol Surg Rep","first-page":"e54","article-title":"Delayed-onset seizures following self-inflicted nail gun injury to the head: a case report and literature review","volume":"83","author":"Hoey","year":"2022","unstructured":"Hoey ATroy CBauerle WXia AHoey B.Delayed-onset seizures following self-inflicted nail gun injury to the head: a case report and literature review. J Neurol Surg Rep. 2022;83(2):e54-e62."},{"key":"bib1","series-title":"Int J Surg Case Rep","first-page":"115","article-title":"Management of a nail impalement injury to the brain in a non-neurosurgical centre: a case report and review of the literature","volume":"19","author":"Agu","year":"2016","unstructured":"Agu CTOrjiaku ME.Management of a nail impalement injury to the brain in a non-neurosurgical centre: a case report and review of the literature. Int J Surg Case Rep. 2016;19:115-118."},{"issue":"3","key":"bib2","series-title":"Ulus Travma Acil Cerrahi Derg","first-page":"265","article-title":"Penetrating head trauma with four nails: an extremely rare case","volume":"18","author":"Ar\u0131c\u0131","year":"2012","unstructured":"Ar\u0131c\u0131 LAkg\u00fcn BKaplan MY\u0131lmaz I.Penetrating head trauma with four nails: an extremely rare case. Ulus Travma Acil Cerrahi Derg. 2012;18(3):265-267."},{"issue":"14","key":"bib3","series-title":"Diagnostics (Basel)","first-page":"1549","article-title":"Repetitive self-inflicted craniocerebral injury in a patient with antisocial personality disorder","volume":"14","author":"Cucu","year":"2024","unstructured":"Cucu AICostea CFSili\u0219teanu SCRepetitive self-inflicted craniocerebral injury in a patient with antisocial personality disorder. Diagnostics (Basel). 2024;14(14):1549."},{"key":"bib4","series-title":"J Med Case Rep","first-page":"58","article-title":"Nail gun injuries to the head with minimal neurological consequences: a case series","volume":"10","author":"Makoshi","year":"2016","unstructured":"Makoshi ZAlKherayf FDa Silva VLesiuk H.Nail gun injuries to the head with minimal neurological consequences: a case series. J Med Case Rep. 2016;10:58."},{"issue":"12","key":"bib5","series-title":"No Shinkei Geka","first-page":"1209","article-title":"Multiple penetrating head injury by 8 nails: a case report","volume":"37","author":"Ichinose","year":"2009","unstructured":"Ichinose NIkawa FOhbayashi NMitsuhara TAbiko MInagawa T.Multiple penetrating head injury by 8 nails: a case report. No Shinkei Geka. 2009;37(12):1209-1213."},{"issue":"4","key":"bib6","series-title":"Acta Neurol Belg","first-page":"767","article-title":"A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder","volume":"115","author":"Xu","year":"2015","unstructured":"Xu MWen JZhu XChen PWang C.A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder. Acta Neurol Belg. 2015;115(4):767-769."},{"issue":"4","key":"bib7","series-title":"Radiol Case Rep","first-page":"334","article-title":"Double penetration wound: a nail gun injury involving the head and heart","volume":"15","author":"Ye","year":"2020","unstructured":"Ye CNLin MCHuang CL.Double penetration wound: a nail gun injury involving the head and heart. Radiol Case Rep. 2020;15(4):334-338."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"377","article-title":"Thirty-two nails injected into the head: an operative report and review of the literature","volume":"13","author":"Zima","year":"2022","unstructured":"Zima LASrinivasan SBudde BKitagawa R.Thirty-two nails injected into the head: an operative report and review of the literature. 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J Neurosurg. 2006;104(5):828-834."},{"issue":"11","key":"bib11","series-title":"Asian J Surg","first-page":"5365","article-title":"Editor-Intracranial penetrating injury by a nail gun: an unusual case report","volume":"46","author":"Wang","year":"2023","unstructured":"Wang HCheng JLong WWang D.Editor-Intracranial penetrating injury by a nail gun: an unusual case report. Asian J Surg. 2023;46(11):5365-5368."},{"issue":"6","key":"bib12","series-title":"Cureus","first-page":"e25581","article-title":"Unique presentation and novel surgical approach to a transcribriform penetrating head injury caused by a nail gun","volume":"14","author":"Hendricks","year":"2022","unstructured":"Hendricks BKDiDomenico JDLawton MTLittle AS.Unique presentation and novel surgical approach to a transcribriform penetrating head injury caused by a nail gun. Cureus. 2022;14(6):e25581."},{"issue":"3","key":"bib13","series-title":"Neurosciences (Riyadh)","first-page":"267","article-title":"Ten self-inflicted intracranial penetrating nail gun injuries","volume":"20","author":"Yuh","year":"2015","unstructured":"Yuh SJAlaqeel A.Ten self-inflicted intracranial penetrating nail gun injuries. Neurosciences (Riyadh). 2015;20(3):267-270."},{"issue":"6","key":"bib14","series-title":"Neurocirugia (Astur)","first-page":"544","article-title":"Multiple penetrating brain injuries caused by a nail gun: a case report","volume":"17","author":"Zazpe","year":"2006","unstructured":"Zazpe IV\u00e1zquez ABeaumont CMultiple penetrating brain injuries caused by a nail gun: a case report. Neurocirugia (Astur). 2006;17(6):544-549."},{"issue":"4","key":"bib15","series-title":"No Shinkei Geka","first-page":"357","article-title":"Penetrating brain injury and traumatic aneurysm caused by a nail gun","volume":"25","author":"Sakuta","year":"1997","unstructured":"Sakuta YArai S.Penetrating brain injury and traumatic aneurysm caused by a nail gun. No Shinkei Geka. 1997;25(4):357-362."},{"issue":"8","key":"bib16","series-title":"J Stroke Cerebrovasc Dis","first-page":"e143","article-title":"Penetrating head injury by a nail gun: case report, review of the literature, and management considerations","volume":"26","author":"Awori","year":"2017","unstructured":"Awori JWilkinson DAGemmete JJThompson BGChaudhary NPandey AS.Penetrating head injury by a nail gun: case report, review of the literature, and management considerations. J Stroke Cerebrovasc Dis. 2017;26(8):e143-e149."},{"key":"bib17","series-title":"World Neurosurg","first-page":"143","article-title":"Management of penetrating brain injury caused by a nail gun: three case reports and literature review","volume":"112","author":"Wu","year":"2018","unstructured":"Wu RYe YLiu CYang CQin H.Management of penetrating brain injury caused by a nail gun: three case reports and literature review. World Neurosurg. 2018;112:143-147."},{"issue":"7","key":"bib18","series-title":"No Shinkei Geka","first-page":"635","article-title":"A penetrating cranio-facial injury due to a nail-gun accident","volume":"25","author":"Inoha","year":"1997","unstructured":"Inoha SSuzuki SFukui MA penetrating cranio-facial injury due to a nail-gun accident. No Shinkei Geka. 1997;25(7):635-639."},{"issue":"2","key":"bib19","series-title":"J Surg","first-page":"31","article-title":"Cranial impalement of a falling fence spike in a child: a case report","volume":"4","author":"Abdullahi Onimisi","year":"2016","unstructured":"Abdullahi Onimisi J.Cranial impalement of a falling fence spike in a child: a case report. J Surg. 2016;4(2):31."},{"issue":"02\/03","key":"bib20","series-title":"Indian J Neurotrauma","first-page":"62","article-title":"An interesting case of penetrating brain injury by a self-hammered nail","volume":"15","author":"Besra","year":"2018","unstructured":"Besra SKHarsh VMishra PSahay CB.An interesting case of penetrating brain injury by a self-hammered nail. Indian J Neurotrauma. 2018;15(02\/03):62-66."},{"issue":"5","key":"bib21","series-title":"Can J Emerg Med","first-page":"788","article-title":"Bilateral nail gun traumatic brain injury presents as intentional overdose: a case report","volume":"20","author":"Alain","year":"2018","unstructured":"Alain JLavergne PSt-Onge MD\u2019Astous MC\u00f4t\u00e9 S.Bilateral nail gun traumatic brain injury presents as intentional overdose: a case report. Can J Emerg Med. 2018;20(5):788-791."},{"issue":"2","key":"bib22","series-title":"J Trauma","first-page":"E59","article-title":"Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm","volume":"63","author":"Springborg","year":"2007","unstructured":"Springborg JBEskesen VOlsen NVGjerris F.Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm. 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Surg Neurol. 2005;64(4):368-371."},{"issue":"2","key":"bib25","series-title":"J Digit Imaging","first-page":"362","article-title":"Wearable mixed-reality holographic navigation guiding the management of penetrating intracranial injury caused by a nail","volume":"34","author":"Li","year":"2021","unstructured":"Li YHuang JHuang TWearable mixed-reality holographic navigation guiding the management of penetrating intracranial injury caused by a nail. J Digit Imaging. 2021;34(2):362-366."},{"issue":"3","key":"bib26","series-title":"Br J Neurosurg","first-page":"448","article-title":"Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note","volume":"37","author":"Nussbaum","year":"2023","unstructured":"Nussbaum ESGraupman PPatel PD.Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note. 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