Self-inflicted penetrating head injuries in patients with paranoid schizophrenia are an infrequent phenomenon. The authors report on a psychiatric patient who presented with epistaxis. Computed tomography showed a nail passing from the nasal cavity into the frontal lobe. Given the proximity to large intracranial vessels, a craniotomy was performed and the nail was retracted. The patient later reported having hammered the nail into the nasal cavity with the intention to “kill the voice in my head.” Despite use of the latest imaging modalities, metal artifacts may have limited the assessment of vascular involvement. Surgical decision-making preventing secondary damage is crucial in them.
*Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland
†Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
‡Department of Otorhinolaryngology, Head and Neck Surgery
§Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern
||Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
Address correspondence and reprint requests to Robert H. Andres, MD, Department of Neurosurgery, University of Bern, Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland; E-mail: email@example.com
Received 3 February, 2017
Accepted 21 March, 2017
This study was approved by the Ethical Committee of Bern (Kantonale Ethikkommision, KEK, Bern, Switzerland), the Swiss Ethic Committee on research involving humans. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
The authors report no conflicts of interest.