Perforating Eyelid Injury Extending to the Brain Stem in a 17-year-old Woman: A Case Report

Eiichiro Noda; Makoto Inoue; Izumi Yoshikawa-Kobayashi; Toshiyuki Nagamoto

Disclosures

J Med Case Reports. 2010;4(1):18 

In This Article

Abstract and Introduction

Abstract

Introduction: This case report describes a patient who had a perforating eyelid injury that extended to the brain stem.
Case presentation: A 17-year-old Japanese woman complained of decreased vision in her right eye, with severe ocular pain and headaches, after the metal tip of an umbrella struck her upper right eyelid accidentally. Her vision in the right eye decreased to light perception with commotio retinae, intraretinal hemorrhage, and severe lid swelling. Magnetic resonance imaging (MRI) demonstrated edema of the head of the caudate nucleus and putamen, and the edema extended to the hypothalamus. The MRI findings indicated that the umbrella tip had penetrated through the eyelid and the posterior orbital wall. Vision improved to 20/50 in the right eye, with subretinal fibrosis caused by the choroidal rupture.
Conclusions: We recommend that MRI be performed on the orbit and brain in patients who appear to have symptoms that are inconsistent with the observed injury and when a severe orbitocranial injury is suspected.

Introduction

Penetrating periorbital wounds are not uncommon, but those that extend to the brain stem are extremely rare.[1,2] Despite the severity of the superficial trauma, injuries that extend into the brain cavity have often been overlooked because they cause only mild symptoms.[3] However, a perforating brain injury is particularly dangerous because a cerebrospinal fluid fistula can lead to meningitis and brain abscess.[4] We describe a patient who suffered accidental perforation of her upper eyelid with the metal tip of an umbrella, and in whom extension of the injury to the midbrain was only identified with computed tomography (CT) and magnetic resonance imaging (MRI).

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