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

Chi-Man Yip^*

Division of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung.

DOI: 10.4236/ss.2012.34040                

Abstract

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.

Keywords

Ball-Pen; Major Depression; Penetrating Head Injury; Self-Inflicted Injury

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. I. Bowen, “Self-Inflicted Orbitocranial Injury with a Plastic Ballpoint Pen,” British Journal of Ophthalmology, Vol. 55, No. 6, 1971, pp. 427-430. doi:10.1136/bjo.55.6.427
[2]	S. Sharif, G. Roberts and J. Phillips, “Transnasal Penetrating Brain Injury with a Ball-Pen,” British Journal of Neurosurgery, Vol. 14, No. 2, 2000, pp. 159-160. doi:10.1080/02688690050004660
[3]	P. Lunetta, A. Ohberg and A. Sajantila, “Suicide by Intracerebellar Ballpoint Pen,” American Journal of Forensic Medicine and Pathology, Vol. 23, No. 4, 2002, pp. 334-337. doi:10.1097/00000433-200212000-00006
[4]	C. Gokcek, Y. Erdem, E. Koktekir, M. Karatay, M. A. Bayar, N. Edebali, et al., “Intracranial Foreign Body,” Turkish Neurosurgery, Vol. 17, No. 2, 2007, pp. 121-124.
[5]	H. L. Lin, H. C. Lee and D. Y. Cho, “Management of Transorbital Brain Injury,” Journal of the Chinese Medical Association, Vol. 70, No. 1, 2007, pp. 36-38. doi:10.1016/S1726-4901(09)70299-0
[6]	A. Al-Anazi, I. Al-Luwimi and M. Nasser, “Transorbital Penetrating Craniocerebral Injury by a Spectacle arm: Suicidal Attempts,” British Journal of Neurosurgery, Vol. 17, No. 4, 2003, pp. 368-369. doi:10.1080/02688690310001601315
[7]	B. Cemil, K. Tun, O. Yigenoglu and E. Kaptanoglu, “Attempted Suicide with Screw Penetration into the Cranium,” Turkish Journal of Trauma & Emergency Surgery, Vol. 15, 2009, pp. 624-627.
[8]	K. Kishore, S. Sahu, P. Bharti, S. Dahiya, A. Kumar and A. Agarwal, “Management of Unusual Case of Self-Inflicted Penetrating Craniocerebral Injury by a Nail,” Journal of Emergency, Trauma and Shock, Vol. 3, No. 2, 2010, pp. 193-196. doi:10.4103/0974-2700.62115
[9]	A. Iordache, J. M. Kaya, J. R. Alliez and B. Alliez, “A Rare Case of Severe Craniocerebral Trauma with Penetrating Head Injury,” Romanian Neurosurgery, Vol. 18, 2011, pp. 77-81.