BACKGROUND: Placing of sewing needles in the brain through the anterior fontanelle was first described in Germany in 1914. Forty cases have been reported in the scientific literature; most of them were identified in Turkey and Iran, with only a few cases in the Far East, North and Eastern Europe, and the United States. The only case observed in Italy was recorded in 1987. In nonmedical literature, this practice was frequently described in Persian novels, and it has been thought that this ritual could have been diffused with the Persian Empire domination over the centuries. OBJECTIVE: We report on a new Italian case of an 82-year-old woman admitted for progressive right hemiparesis and gait disturbance. METHODS: Brain computed tomography scan showed a left frontoparietal chronic subdural haematoma and, surprisingly, three 4-cm-long sewing needles inserted through the region of the anterior fontanelle. The patient and her friends and family did not remember any event justifying their presence. RESULTS: Subdural collection was evacuated by craniotomic approach, and the sewing needles were left in place and followed up. CONCLUSION: The rare cases of intracranial needling reported in the literature may represent only the tip of the iceberg. The phenomenon is usually reported as an incidental finding in asymptomatic adults, whereas many babies could not have been diagnosed because they died. The therapy remains controversial, although many authors suggest only follow-up for asymptomatic patients. In this article, all the pertinent literature is reviewed and the most important clinical aspects are discussed, along with a historical assessment of the problem.
BACKGROUND: Placing of sewing needles in the brain through the anterior fontanelle was first described in Germany in 1914. Forty cases have been reported in the scientific literature; most of them were identified in Turkey and Iran, with only a few cases in the Far East, North and Eastern Europe, and the United States. The only case observed in Italy was recorded in 1987. In nonmedical literature, this practice was frequently described in Persian novels, and it has been thought that this ritual could have been diffused with the Persian Empire domination over the centuries. OBJECTIVE: We report on a new Italian case of an 82-year-old woman admitted for progressive right hemiparesis and gait disturbance. METHODS: Brain computed tomography scan showed a left frontoparietal chronic subdural haematoma and, surprisingly, three 4-cm-long sewing needles inserted through the region of the anterior fontanelle. The patient and her friends and family did not remember any event justifying their presence. RESULTS: Subdural collection was evacuated by craniotomic approach, and the sewing needles were left in place and followed up. CONCLUSION: The rare cases of intracranial needling reported in the literature may represent only the tip of the iceberg. The phenomenon is usually reported as an incidental finding in asymptomatic adults, whereas many babies could not have been diagnosed because they died. The therapy remains controversial, although many authors suggest only follow-up for asymptomatic patients. In this article, all the pertinent literature is reviewed and the most important clinical aspects are discussed, along with a historical assessment of the problem.