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September 1982

Bilateral Papilledema and Self-Mutilation

Author Affiliations

Armed Forces Institute of Pathology Washington, DC 20306
F. A. Horton Hospital Middletown, NY 10940

Arch Neurol. 1982;39(9):604. doi:10.1001/archneur.1982.00510210074032

To the Editor.—  Persons with self-inflicted ocular mutilation have an unusual form of psychotic behavior1 that, on occasion, may be associated with abnormal purine metabolism.2,3 We recently helped care for a 29-year-old woman who sustained self-inflicted facial trauma and in whom bilateral papilledema later developed. Her clinical course suggested the presence of an intracranial mass, but the results of her neurologic evaluation were unremarkable. Pathologic examination of her self-enucleated right eye showed that the papilledema was related to meningitis of the optic nerve from apparently self-introduced intraorbital foreign material.

Report of a Case.—  A 29-year-old woman had a one-year history of compulsive self-mutilation, characterized mainly by bouts of punching herself in the face. Her behavior was not modified by major tranquilizers. She had been hospitalized twice for self-inflicted trauma, including a superficial laceration of her throat. During her last hospitalization, she sustained bilateral corneal abrasions, conjunctival lacerations, and

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