An unexpected intracranial blade

While self-mutilations with stab wounds are relatively common in psychiatric patients suffering from schizophrenia and personality disorders, they are rarely performed as suicidal attempts. Even in psychotic patients, suicidal stab wounds of the skull are rare in the literature. We report the case of a 34-year-old schizophrenic man whom emergency medical services (EMS) providers cared for at his home because of a complete self-amputation of his right hand, without any other apparent wound than a facial laceration. The patient was transferred to the acute surgical ward for evaluation of the possibility reimplantation of the amputated hand. When his neurologic status rapidly declined after hospital admission, a whole-body computed tomography (CT) scan was performed for other injuries. Unexpectedly, cerebral CT scan showed the presence of an intracranial 11-cm-long blade, whose distal tip was located in the left temporal cerebral lobe. Given the nature of the cerebral injuries on CT scan and the major impairment of the neurologic status of the patient, the neurosurgeon considered surgical extraction of the blade to be futile, and the patient's condition rapidly deteriorated to brain death.