gms | German Medical Science

Objective: Self-inflicted non-missile penetrating brain injuries are rare and unusual among civilian population. In this case report we describe a self-inflicted penetrating brain injury of a 41 year old male patient in case of suicide attempt in an acute schizophrenic episode by an electric drill. Neuroimaging studies are described and a review of the operative and clinical management concerning this rare pathology is done.

Methods: The 41 year old male patient with schizophrenic disorder was admitted via the emergency department in our clinic. He reported about an accident while working with an electric drill. Physical examination of the awake and adequate patient (GCS15) revealed right lower extremity paresis, no loss of sensibility and a penetrating rounded scalp wound to the left parasagittal region. The CT−scan showed a drill hole (5mm diameter) in the left parasagittal region with small bone fragments, a slight subarachnoid hemorrhage and an intraparenchymal hematoma (1.5x1.8x2.5cm) with no mass effect in the central region. A psychiatric evaluation ruled out a suicide attempt in an acute schizophrenic episode. The patient was transferred to the ICU for observation of his neurological status. Follow up CT−scan with CT−angiogram after 2 hrs showed no signs of vascular lesion but a progress of the intraparenchymal hematoma (5x2x3cm) with a mass effect. The reexamination of the patient showed a right hemiplegia. The patient was taken immediately to the operating room for intraparenchymal hematoma evacuation via craniotomy. Antibiotic prophylaxis was administered. Intraoperatively there were no sinusoidal vein affections or arterial lesions. Postoperatively the patient was observed for 3 days on ICU. Postoperative CT−scan showed a regular result after intraparenchymal hematoma evacuation and no signs of secondary bleeding. The patient’s neurostatus improved with slight motoric function of the right upper extremity but persistent plegia for the right lower extremity. To exclude a false aneurysm a cerebral angiography was performed before discharge to the psychiatric department. No signs of artery abnormalities were registered in the vascular imaging.

Results: Nine days after the operation patient could transfer for specific anti-schizophrenic treatment to the psychiatric department. Patient’s right hand mobility improved further, but right lower extremity plegia continued. Wound healing showed no signs of infections.

Conclusion: A self-inflicted penetrating brain injury by an electric drill is a rare entity. It is essential to exclude a penetrating brain trauma whenever a scalp wound is noticed in order to provide proper medical treatment. Cerebral vein affections and arterial lesions should excluded by a CT−angiogram and cerebral angiography if necessary. Neurological deficits are related to the degree and location of the primary injury.