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The nail enters the right squamous temporal bone, just posterior to the sphenosquamous suture. No associated skull fracture. It passes through the right temporal and inferior right frontal lobes, with the tip lying in the midline of the third ventricle. There is beam hardening artefact around the nail. With that limitation, no acute intracranial haemorrhage. No pneumocephalus. No shift in midline structures. The ventricles and CSF spaces are normal.
CT Angiogram: The nail passes just above and anterior to the M2 branch of the right MCA. No arterial injury identified, within the limits of this study. The remainder of the circle of Willis, the carotid arteries, and the vertebral arteries opacify normally.