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Logo of neurologyNeurologyAmerican Academy of Neurology
Neurology. 2016 April 5; 86(14): 1358–1359.
PMCID: PMC4826342

Open traumatic brain injury by nail gun resulting in a persistent vegetative state

A 64-year-old man presented to the trauma bay with metallic objects protruding from his right scalp following presumed assault. Clinical examination demonstrated an unresponsive, moderately hypertensive patient with reactive pupils, intact corneal and gag reflexes, and no movement to noxious stimuli (Glasgow Coma Scale1 3T). Neuroimaging demonstrated multiple linear metallic foreign bodies extending deep into the bilateral thalami and brain parenchyma (figure 1). The patient underwent a right decompressive hemicraniectomy and removal of seven 10-inch nails through the skull via the right frontal and temporal cortices (figure 2). The patient recovered and remains in a persistent vegetative state, likely from his diencephalic injury.2

Figure 1
Preoperative radiographic imaging
Figure 2
Intraoperative photographs


Author contributions: Jayesh P. Thawani drafted the manuscript and edited the figures. Timothy H. Lucas drafted/edited the manuscript and was the treating physician.

Study funding: No targeted funding reported.

Disclosure: The authors report no disclosures relevant to the manuscript. Go to for full disclosures.


1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974;2:81–84. [PubMed]
2. Kinney HC, Korein J, Panigrahy A, Dikkes P, Goode R. Neuropathological findings in the brain of Karen Ann Quinlan: the role of the thalamus in the persistent vegetative state. N Engl J Med 1994;330:1469–1475. [PubMed]

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