Large orbital extraconal hematoma causing proptosis

Case contributed by Assoc Prof Craig Hacking

Presentation

Unwitnessed fall. Found confused on the ground. On oral anticoagulation.

Patient Data

Age: 80 years
Gender: Male

Large right cerebral convexity acute subdural hematoma measuring up to 19 mm in depth. Small left acute SDH with maximum thickness of 4 mm.

Effacement of the adjacent cortical sulci and right lateral ventricle with associated subfalcine herniation and leftward midline shift of 10 mm. No evidence of ACA infarction. No transtentorial or tonsillar herniation. No hydrocephalus.

Large left retrobulbar hematoma, abutting the superior and lateral orbital walls within the extraconal fat planes, measuring 38 x 25 x 19 mm. This depresses the extraocular muscles and globe, resulting in significant proptosis. The globe is intact. Large left periorbital hematoma with laceration. The right orbit is normal. No orbital fracture.

No skull fracture elsewhere.

The paranasal sinuses and mastoid air cells are well-aerated. No skull fracture.

IMPRESSION

  1. Right cerebral convexity acute SDH with 10 mm leftward midline shift. Small left SDH.
  2. Large left retrobulbar hematoma with significant proptosis. Urgent ophthalmology opinion advised.

Case Discussion

The patient had a lateral canthotomy in the emergency department and neurosurgically conservatively managed and palliated.

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Case information

rID: 79909
Published: 8th Jul 2020
Last edited: 28th Mar 2021
Inclusion in quiz mode: Included

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