RESUMO
STUDY DESIGN: Case report and review of literature. OBJECTIVE: To present the rare case of a 70-year-old man with a punctured cranial lesion, who was treated with surgery and had a positive recovery. SUMMARY OF BACKGROUND DATA: Cerebral trauma as the serious consequence of urban aggressiveness. METHOD: Clinical and imagery review of a cranial puncture trauma caused by a metal railroad nail, which penetrated the cranium, dura mater, frontal cerebral parenchyma and deep structures, lodging itself next to the midline, without damaging the superior sagittal sinus. RESULTS: The patient underwent a frontal craniotomy to remove the metal nail. He was hospitalized 2 weeks post-surgery and discharged. During external consultations, he manifested no neurologic deficit. A post-surgical CT ruled-out a brain abscess or other complications. CONCLUSIONS: Skull and brain stab wound lesions are highly infrequent, but evaluating the mechanism of injury and the successful medical and surgical treatment employed is illustrative of how post-traumatic recovery of this severe head injury can be achieved. The site of the injury and the position of the object were decisive for establishing an adequate diagnosis and prognosis. The patient reported an exemplary recovery without any secondary complications.