Abstract
BACKGROUND: 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. OBSERVATIONS: 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. LESSONS: 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. https://thejns.org/doi/10.3171/CASE25103.