title: Self-inflicted orbital and intracranial injury with a retained foreign body, associated with psychotic depression: case report and review.
abstract: Reports of intracranial self-mutilation by psychotic individuals are associated with severe mental disorders, criminality, or both. We describe a psychotically depressed male who drove a ballpoint pen through his right medial canthus and into his intracranial compartment. The patient developed a cavernous sinus syndrome and a traumatic dissection of the cavernous portion of the carotid artery. The pen was removed intraoperatively. Postoperatively, the patient was placed on a course of broad-spectrum antibiotics, antidepressants, and antipsychotic medications, and he has received long-term psychiatric follow-up. The literature related to these unusual cases is reviewed, and relevant surgical, medical, and psychiatric aspects of treatment are discussed.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ 85013.
authors.forename: K A
authors.initials: KA
authors.lastname: Greene
authors.forename: C A
authors.initials: CA
authors.lastname: Dickman
authors.forename: K A
authors.initials: KA
authors.lastname: Smith
authors.forename: E J
authors.initials: EJ
authors.lastname: Kinder
authors.forename: J M
authors.initials: JM
authors.lastname: Zabramski
mesh_terms: D000328:Adult; D002426:Cavernous Sinus / Q000293:injuries*; D003866:Depressive Disorder / Q000150:complications* / Q000628:therapy; D005547:Foreign Bodies / Q000150:complications / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D009915:Orbit / Q000293:injuries*; D012652:Self Mutilation; D014950:Wounds, Penetrating / Q000150:complications / Q000523:psychology* / Q000628:therapy