Volume 3 Issue 6 June, 2013
Do not underestimate physical examination
I was called to see a patient, aged around 50 yrs. He appeared unkempt, apathetic and had no emotional expressions. The person accompanying him, his brother, said that he has been complaining of headache for last 2 days. Patient was ill with schizophrenia for more than 20 yrs, not received proper treatment and partially dysfunctional. He was a carpenter by occupation. When asked to show where exactly the ache is, he appointed to his vortex. It appeared as though he was giving a complaint just because he has to report something to justify being brought to hospital. However, I just passed my hand over his vortex and I did feel a circular patch over the area that appeared hard. I thought it to be a scar of an old injury. I took a torch and saw. I could see a circular metallic thing, buried in the hair which appeared like head of a nail. I could not believe that there is nail stuck there over the vortex. On asking the patient said that it induced is a nail which he himself had driven in 2 days ago as ordered by a voice. On asking he said that he himself had done it with a hammer. Surprisingly he had no neurological deficits. There was no bleeding at the site. The relatives did not believe me when I told them about it. He was referred to Neurosurgeon who with a CT‐head confirmed that there was a 3 inch nail passing through the sutures of skull right into the sagital sinus and lodged between the 2 hemispheres. It was removed subsequently and patient was discharged. He has been reported to be on antipsychotics and doing better. The incident highlights the need for physical examination and not to dismiss any physical complaints in a chronic mentally ill.
