This patient presented with a self-harm injury. 

The pen missed the optic nerve, the middle cerebral artery and any eloquent brain. A cerebral angiogram was performed which was normal except for truncation of the ophthalmic artery (not shown). The pen was removed under fluoroscopic guidance. Upon removal, there was brisk bleeding from the ophthalmic artery. Endovascular embolization of the bleeding vessel was performed with coils, with good result. The patient’s pupil remains reactive, suggesting a good prognosis for the optic nerve and the patient’s vision.