A tale of the nail: post-traumatic brain abscess from impalement injury

Impalement injuries to the head are rare but serious and potentially life-threatening. They comprise approximately 0.3% of all head injuries and require emergency surgical intervention. These injuries are mostly accidental however increasing cases arising from assault is being reported with often satisfactory outcomes. The management of impalement injuries to the brain presents peculiar challenges due to their complexities, associated neurological disruptions and impairments, and the risk of central nervous system infection. Cerebral abscess is a rare but potentially devastating complication of cranial impalement injuries often associated with late presentations and cases receiving suboptimal treatment. We report a fatal case of cerebral abscess in a 33-year-old man who presented late following assault with a nail to his head. We outline the principles of management, emphasize the need for early presentation and management by qualified professionals.