Traumatic intracranial nail-gun injury of the right internal carotid artery causing pseudoaneurysm and caroticocavernous fistula

Christopher Alan Brooks; Ashraf Dower; Andrew Bonura; Nathan Manning; James Van Gelder

doi:10.1136/bcr-2021-243789

Traumatic intracranial nail-gun injury of the right internal carotid artery causing pseudoaneurysm and caroticocavernous fistula

BMJ Case Rep. 2021 Aug 24;14(8):e243789. doi: 10.1136/bcr-2021-243789.

Authors

Christopher Alan Brooks^{1

2

3

4}, Ashraf Dower^{3

5}, Andrew Bonura^{6

7

8}, Nathan Manning^{9

10}, James Van Gelder^{11

2

3

4}

Affiliations

¹ The School of Medicine, The University of Sydney, Sydney, New South Wales, Australia brooks.christopher.alan@gmail.com.
² Neurosurgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
³ Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia.
⁴ The Sydney Spine Institute, Sydney, New South Wales, Australia.
⁵ Neurosurgery, Westmead Hospital, Sydney, New South Wales, Australia.
⁶ Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.
⁷ Radiology, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
⁸ The School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
⁹ Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.
¹⁰ The Ingham Institute, Sydney, New South Wales, Australia.
¹¹ The School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Penetrating trauma due to nail gun is an uncommon yet important clinical entity. There are numerous case reports describing these injuries, yet few describe those resulting in cerebrovascular injury. Laceration of cerebral blood vessels may result in significant intracranial haemorrhage and cerebral ischaemia, with catastrophic consequences. In the present study, we report a female patient who was shot in the face with a nail gun in a domestic assault. The nail entered her right cavernous sinus and lacerated her right internal carotid artery causing a pseudoaneurysm and a caroticocavernous fistula. This report details the approach to, and pitfalls of, managing a cerebrovascular injury due to penetrating intracranial nail. Catheter cerebral angiography is essential in the diagnosis and treatment of these injuries. Best treatment and outcomes require clinicians with expertise in endovascular and surgical repair strategies.

Keywords: neurological injury; neurosurgery; trauma CNS /PNS.

Publication types

Case Reports

MeSH terms

Aneurysm, False* / diagnostic imaging
Aneurysm, False* / etiology
Aneurysm, False* / surgery
Carotid Artery, Internal / diagnostic imaging
Carotid Artery, Internal / surgery
Carotid-Cavernous Sinus Fistula* / diagnostic imaging
Carotid-Cavernous Sinus Fistula* / etiology
Carotid-Cavernous Sinus Fistula* / surgery
Cerebral Angiography
Craniocerebral Trauma*
Female
Humans