Incidentally Discovered a Self-Inflicted a Nail in the Brain of Schizophrenia Patient

Abstract

The self-infliction of foreign bodies into the brain represents rare a clinical phenomenon that has been reported primarily in cases involving accidents and suicide attempts. However, various motivations for self-injurious behaviors as well as suicide attempts have been reported, especially in patients with psychotic illnesses. A 47-year-old man with a history of schizophrenia presented to our hospital due to the presence of a nail on his plain skull X-ray. He diagnosed paranoid type of schizophrenia about 17 years earlier, and his psychiatric symptoms were well controlled by medication. Interestingly, he was not aware of the presence of the nail in his brain and showed no neurological deficits. In the course of detailed history taking, we discovered that the nail was driven into his brain during a hallucinatory experience that had occurred more than 10 years earlier. Because we believed that removing the nail from his brain would be more dangerous than maintaining the status quo, the nail was not removed. This is a very rare case of a self-inflicted injury involving inserting a nail into the brain under the influence of hallucinations. The absence of adverse effects or neurological symptoms/signs related to the presence of a foreign metallic body in the brain for over 10 years is exceptional.

An Interesting Case of Penetrating Brain Injury by a Self-Hammered Nail

“…7 Psychological assessment of the patients with PBI is essential who have attempted suicide or homicide as they may have psychiatric illnesses. 18 The guidelines for medical and surgical management of PBI have been laid down in the Guidelines for the Management of Penetrating Brain Injury. 2 In patients with PBI, an assessment followed by correction of airway, breathing, and circulation should be performed by the attending physician.…”

Penetrating intracranial nail-gun injury to the middle cerebral artery: A successful primary repair

“…Most of these injuries are primarily work-related accidents but are also commonly reported as intentionally self-inflicted. [ 10 15 17 ]…”

“…Psychotic illnesses such as depression and schizophrenia have been associated with these types of injuries. [ 17 ]…”

Unusual foreign body insertion in rectum and vagina in schizophrenic patient

“…This behaviour may be because of delusional beliefs or a response to command hallucinations, as well as to commit suicide, especially in schizophrenia. 6,7 The other causes of foreign body insertion are mood disorder, personality disorder, suicide have reported with insertion of foreign bodies 7 . The group of patients with foreign body insertion include children (75-80%), psychiatric patients especially with suicidal tendencies, substance abusers, prisoners,.…”

“…most of the foreign bodies are of nonfood related. [6][7][8] Here we report a 21 year old female patient. Our patient had history of insertion of ball pen in rectum and vagina following command hallucination ( figure 1 and figure 2).…”