# Repetitive Self-Inflicted Craniocerebral Injury in a Patient with Antisocial Personality Disorder

## TL;DR

A prisoner with antisocial personality disorder repeatedly inserted metal objects into his skull over four years, which were safely removed each time.

## Contribution

This case highlights a rare phenomenon of repetitive self-inflicted craniocerebral injuries in a patient with a mental disorder.

## Key findings

- The patient inserted six metal foreign bodies into his skull over four years.
- Computed tomography showed metal objects passing through the frontal bone into the frontal lobe.
- Safe surgical extraction was possible with proper preoperative planning despite metal artifacts.

## Abstract

Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. Computed tomography each time revealed the presence of a metal foreign body (screw, nail, metal rod, and wire) passing through the frontal bone into the frontal lobe. In each situation, the foreign body was safely extracted with a favorable outcome. Despite the use of the latest imaging modalities, metal artifacts can limit the assessment of vascular involvement, and special attention must be given to preoperative planning. Surgical extraction of the foreign body can be safely performed when appropriate preoperative planning is carried out to consider all possible complications.