An Unexpected Intracranial Blade

Abstract

While self-mutilations with stab wounds are relatively common in psychiatric patients suffering from schizophrenia and personality disorders, they are rarely performed as suicidal attempts. Even in psychotic patients, suicidal stab wounds of the skull are rare in the literature. We report the case of a 34-year-old schizophrenic man whom emergency medical services (EMS) providers cared for at his home because of a complete self-amputation of his right hand, without any other apparent wound than a facial laceration. The patient was transferred to the acute surgical ward for evaluation of the possibility reimplantation of the amputated hand. When his neurologic status rapidly declined after hospital admission, a whole-body computed tomography (CT) scan was performed for other injuries. Unexpectedly, cerebral CT scan showed the presence of an intracranial 11-cm-long blade, whose distal tip was located in the left temporal cerebral lobe. Given the nature of the cerebral injuries on CT scan and the major impairment of the neurologic status of the patient, the neurosurgeon considered surgical extraction of the blade to be futile, and the patient's condition rapidly deteriorated to brain death.

Suicidal or Homicidal Sharp Force Injuries? A Review and Critical Analysis of the Heterogeneity in the Forensic Literature

“…The data collected from reviewing the literature concerning suicidal and homicidal injuries are summarized in Table .…”

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

“…The hypothesis that patients are insensitive to information about the world outside is based on clinical observations, according to which they are less reactive to pain and negative pictures. The most spectacular observations are the severe self-mutilations observed in acute phases of schizophrenia 4 . Other observations concern chronic patients, who fail to signal pain in the case of somatic diseases 5 6 .…”

Non-missile penetrating brain injuries: cases registry in Sohag University Hospital

“…Early mortality may be caused by hemorrhages, major vascular injury, or contusions, while epileptic seizures and infections are among the possible complications in later stages. Complete excision of the foreign object should be done for all patients and any dural and/or vascular injuries should be repaired during surgical treatment [5].…”