Penetrating brain injury via orbit

Case contributed by A.Prof Frank Gaillard

Presentation

Golf club shaft to face.

Patient Data

Age: 25 years

The pattern of injury is consistent with a penetrating injury through the orbit and into the brain with orbital fractures and a haemorrhagic tract seen. 

The fracture is identified through the orbital apex extending into the lateral wall silhouette sinus are better appreciated on the recent CT facial bones. Stable proptosis. No MR evidence of injury to the globe.

A cylindrical region of signal dropout compatible with blood product extends back from the orbital apex lateral to the cavernous sinus, skimming the mesial temporal lobe and superior aspect of the right cerebellar hemisphere to terminate adjacent to the posterior free edge of the tentorium cerebelli representing the pathway of penetrating injury. There is surrounding high T2 signal and areas of cortical diffusion restriction and petechial haemorrhage surrounding the pathway within the mesial temporal lobe and superior right cerebellar hemisphere. The cerebral peduncle and pons are spared.

Thin layer of right sided subdural haematoma extends along the falx and right tentorium. Small right subdural convexity subdural haematoma. Trace of subarachnoid haemorrhage in right frontoparietal and left occipital sulci. Subarachnoid haemorrhage is present near the vertex. Haemorrhage is present in the occipital horn of the right lateral ventricle.

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Case information

rID: 56193
Case created: 16th Oct 2017
Last edited: 2nd Nov 2017
Inclusion in quiz mode: Included

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