An unsuspected intracranial foreign body on the acute medical unit.

A 54-year-old man was referred to the acute medical unit with a suspected stroke after presenting to his general practitioner with altered speech, left sided facial droop and confusion. The patient had a new right sided swelling on the lateral aspect of his head but did not report any history of trauma. Imaging revealed a 9.2 cm nail entering via the right parietal bone with associated acute haemorrhage. After further discussion with the patient, he disclosed a suicide attempt with a nail gun 5 days prior to presentation. The nail was successfully removed by the neurosurgical team and the patient received rehabilitation and psychiatric assessment on the brain injury unit before going home.