We present the case of a 19-year-old man who suffered a penetrating injury to the brain with a largecalibre steel industrial prybar approximately 1 m long and 2.5 cm wide that was retained in his cranium. The management of this type of injury is discussed, based on our experience with penetrating brain injuries with large-calibre retained objects, from initial presentation to surgical removal of the object to post-operative care. Additionally, given the similarities of the injuries suffered by our patient with those of Phineas Gage, we discuss the extensive lessons learned in treating this type of large-calibre injury.