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Self-inflicted blindness and Brown-Séquard syndrome.
Tim L Gray1, Arthur Karagiannis, John L Crompton
1Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia.
Summary
A psychotic episode led to severe self-inflicted eye and spinal cord injuries in a paranoid schizophrenia patient. This case highlights the critical need for managing psychiatric emergencies in confined public spaces.
Area of Science:
- Neuroscience
- Ophthalmology
- Psychiatry
Background:
- Schizophrenia is a severe mental disorder characterized by psychosis.
- Psychotic episodes can manifest with unpredictable and dangerous behaviors.
- Air travel presents unique challenges for managing acute psychiatric crises.
Observation:
- A 30-year-old male with paranoid schizophrenia experienced a psychotic episode during a flight.
- The patient self-injured by inserting sunglass temples into his orbits and impacting his neck.
- Immediate medical attention was required due to the severity of the trauma.
Findings:
- Bilateral medial orbital penetration by sunglass temples resulted in optic nerve trauma.
- The patient sustained a Brown-Séquard syndrome due to spinal cord hemitransection.
- Complete loss of light perception in both eyes was documented.
Implications:
- This case underscores the potential for extreme self-harm during psychotic episodes, even in unusual settings.
- Effective in-flight psychiatric emergency protocols are crucial for passenger and crew safety.
- Prompt diagnosis and management of traumatic optic neuropathy and spinal cord injury are vital for patient outcomes.