Abstract
BACKGROUND: Nail gun injuries to the brain are rare but increasingly more common in patients with suicidal ideation and psychiatric disturbances. Utilizing a bio-psycho-socio-ecological (BPSE) prism, the authors of this article describe the treatment and outcome of a patient with a history of psychiatric episodes who presented with a self-inflicted bilateral penetrating brain injury by nail gun. The patient described in this report initially had no formal psychiatric diagnosis but was subsequently diagnosed with schizoaffective disorder following the injury. OBSERVATIONS: A 28-year-old male presented to the emergency department after sustaining a self-inflicted nail gun injury to the right parieto-occipital and left frontoparietal region of the head. The authors review the current literature on the treatment and outcomes of nail gun injuries while providing a narrative account of the biological, psychosocial, and ecological factors that can influence and modify the patient's injury and course of care. LESSONS: The case illustrates the importance of exploring the BPSE context of patients with TBI to guide multidisciplinary care that optimizes outcomes and to inform prevention strategies that can reduce the incidence of similar injuries. https://thejns.org/doi/10.3171/CASE24520.