Management of unusual case of self-inflicted penetrating craniocerebral injury by a nail

Kishore, Kamal; Sahu, Sandeep; Bharti, Pradeep; Dahiya, Subhash; Kumar, Ajay; Agarwal, Anurag

doi:10.4103/0974-2700.62115

Cited by 16 publications

(22 citation statements)

References 16 publications

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“…These injuries can be happened in industrial accidents, car accidents, fall accidents or criminal activities [4,5]. From literatures, some of these injuries occurred in psychiatric patients attempting suicide and the causative objects described in the clinical reports include nail, pencil, ball-pen, toothbrush, harpoon, spectacle arm, screw, ice pick, chopsticks, metallic wires, sewing needles [1][2][3][4][6][7][8][9]. To date, there are only 3 English literatures reporting self-inflicted penetrating brain injury with a ball-pen; in all of these reports, the ballpens got into the brain either passing through the orbit or the nasal cavity and paranasal sinus which are thin and delicate bones [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

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Attempt Suicide by Inserting a Ball-Pen into the Brain: A Case Report

Yip¹

2012

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Purpose: Closed head injuries are more common than penetrating head injuries in our clinical practices. Penetrating head injuries can be happened in industrial accidents, car accidents, fall accidents or criminal activities, also they can be occurred in self-inflicted injuries. We reported a case of self-inflicted penetrating head injury to highlight the importance of suicide precaution and review the principle of management of penetrating head injury. Methods and Results: A 58 year-old woman, who has hypertension and major depression, attempted suicide by inserting a ball-pen into her brain through the right temple in the psychiatric ward. CT of brain showed a foreign body penetrating through the right sphenoid ridge to intracranial right frontal-temporal junction, right parasella and suprasella cistern to interpeduncular cistern and acute subarachnoid hemorrhage in the basal cistern and right sylvian fissure. She underwent an emergent neurosurgical procedure to remove the ball-pen, to evacuate the intracranial hematoma and to repair the lacerated dura. She recovered gradually and was clear after surgery, but a right oculomotor palsy and very mild left hemiparesis were left. Discussion: We learn a lesson from this patient, even a ball-pen can become a weapon in the hands of depression patients. All clinicians should be aware of the psychological condition of each patient and suicide precaution should be kept in mind in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…The goals of surgery are removal of the foreign bodies and bone fragments, debridement of the path, evacuation of hematoma, and repair of vascular or dural damage [2,4,5,7,9]. All self-inflicted injured patients should have a complete psychiatric evaluation and treatment is necessary when indicated [4,8].…”

Section: Discussionmentioning

confidence: 99%

Attempt Suicide by Inserting a Ball-Pen into the Brain: A Case Report

Yip¹

2012

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“…The majority of reports about self-inflicted foreign bodies in the brain involve accidents or suicide attempts 1,2. However, patients with psychotic illnesses have reported various motivations for self-injurious behaviors involving the brain such as the removal of evil from the head,3 obedience to auditory hallucinations,4 and frank suicide attempts 5,6.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients with psychotic illnesses have reported various motivations for self-injurious behaviors involving the brain such as the removal of evil from the head,3 obedience to auditory hallucinations,4 and frank suicide attempts 5,6. Because in almost all reported cases, patients with self-inflicted foreign bodies in the brain have been aware of their injuries, the intervals between insertion of the foreign body and hospital care have been relatively short 2-8. In a few cases, however, the patient was not aware of the injury, and the presence of the foreign body in the brain was detected a few months9 or even several years after the original injury,10 when it had produced neurological signs or symptoms.…”

Section: Introductionmentioning

confidence: 99%

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

Son

Kang

Kim³

et al. 2011

Psychiatry Investig

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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.

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“…[1] The authors correctly state that this form of injury is rare. However, intracranial self-stabbing (ICSS) might not be as rare as one might believe.…”

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confidence: 99%