title: Bilateral nail gun traumatic brain injury presents as intentional overdose: A case report.
abstract: This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. Although voluntary intoxication is the most frequent form of suicide attempt, emergency physicians must be alert and maintain a broad differential diagnosis. Although rare, penetrating head injuries have increased in recent decades. As neurological symptoms can be minimal and penetration wounds small, this type of injury could potentially be overlooked.
authors.affiliation: *Department of Emergency Medicine,CHU de Québec - Université Laval,Quebec City,QC.
authors.forename: Judith
authors.initials: J
authors.lastname: Alain
authors.affiliation: †Department of Surgery,CHU de Québec - Université Laval,Quebec City,QC.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lavergne
authors.affiliation: ‡Trauma - Emergency - Critical Care Medicine,CHU de Quebec Research Centre,Quebec City,QC.
authors.forename: Maude
authors.initials: M
authors.lastname: St-Onge
authors.affiliation: †Department of Surgery,CHU de Québec - Université Laval,Quebec City,QC.
authors.forename: Myreille
authors.initials: M
authors.lastname: D'Astous
authors.affiliation: *Department of Emergency Medicine,CHU de Québec - Université Laval,Quebec City,QC.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Côté
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000175:diagnosis; D004636:Emergency Service, Hospital; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Nail gun; craniocerebral injury; overdose; penetrating brain injury; penetrating cranial trauma; self-inflicted injury; suicide