Suicide by intracerebellar ballpoint pen

Self-inflicted eye injuries among psychiatric patients are relatively common. Transorbital penetrating traumas are more rare but if undiagnosed may cause lethal intracranial lesions. We report a fatal case of a 25-year-old schizophrenic man who introduced a plastic ballpoint pen through his right orbit up to the cerebellum. The computed tomography findings were misinterpreted as a penetrating track from a bullet. The patient died 4 days after the trauma, and the causative object was identified only at autopsy. When no precise information about an apparently trivial ocular trauma is available, clinicians and investigators must adequately consider, especially in psychiatric patients, the possibility of an intracranial penetrating lesion.