Incidentally Discovered a Self-Inflicted a Nail in the Brain of Schizophrenia Patient

The self-infliction of foreign bodies into the brain represents rare a clinical phenomenon that has been reported primarily in cases involving accidents and suicide attempts. However, various motivations for self-injurious behaviors as well as suicide attempts have been reported, especially in patients with psychotic illnesses. A 47-year-old man with a history of schizophrenia presented to our hospital due to the presence of a nail on his plain skull X-ray. He diagnosed paranoid type of schizophrenia about 17 years earlier, and his psychiatric symptoms were well controlled by medication. Interestingly, he was not aware of the presence of the nail in his brain and showed no neurological deficits. In the course of detailed history taking, we discovered that the nail was driven into his brain during a hallucinatory experience that had occurred more than 10 years earlier. Because we believed that removing the nail from his brain would be more dangerous than maintaining the status quo, the nail was not removed. This is a very rare case of a self-inflicted injury involving inserting a nail into the brain under the influence of hallucinations. The absence of adverse effects or neurological symptoms/signs related to the presence of a foreign metallic body in the brain for over 10 years is exceptional

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome.

How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.Patients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.A total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03-1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01-1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.Short-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day

Statistical association between SBP_SD and primary outcomes.

<p>Daily SBP_SD values were investigated for END#D1(A), END#D2 (B), and END#D3 (C). In multivariable analysis, the interaction term SD#D1 × SD#D2 was included in model B and SD#D1 × SD#D2, SD#D1 × SD#D3, SD#D2 × SD#D3, and SD#D1 × SD#D2 × SD#D3 were included in model C.</p

Comparisons of daily SBP parameters according to daily END.

<p>The daily means (A) and standard deviations (B) of SBP are shown as patients with END (box) and without END (circle).</p

Association of baseline characteristics with daily SBP_SD.

<p>Association of baseline characteristics with daily SBP_SD.</p

Associations between daily SBP_SD and END.

<p>Associations between daily SBP_SD and END.</p

Daily SDs of SBP and 3-month functional outcome.

<p>Daily SDs of SBP and 3-month functional outcome.</p