Transnasal penetrating brain injury with a ball-pen

We report a case of a 44-year-old man with 1 day's history of epistaxis. He was an in-patient in a psychiatric ward with a history of depression. He had CSF rhinorrhoea, was confused and had no focal neurological deficits. A full length pencil was removed from his left nostril in the emergency department. CT of the brain revealed a tract, but also suggested another foreign body in the inter-hemispheric space. He had a para-sagittal craniotomy and a 14 cm ball-point pen was found lying between the two cerebral hemispheres. This was removed and the patient made an uneventful recovery. This is the first report of an attempted suicide by transnasal insertion of a ballpoint pen intracranially.