Traumatic pneumocranium, cribriform plate fracture and subarachnoid haemorrhage
Assault. Punched to the left eye. Significant alcohol consumption. Left periorbital swelling and deformity. Headache.
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Extensive intracranial gas felt to originate from the significantly displaced fracture of the left ethmoidal roof (cribriform plate fracture), with bony fragments protruding into the inferior mesial edge of the left frontal lobe. There is a risk of intracranial infection. There is marked left periorbital soft tissue gas and marked extraconal gas in the left orbit inferiorly, medially and laterally.
There is subarachnoid haemorrhage in this region and parenchymal haematoma/contusion in the inferior mesial right frontal lobe. Left proptosis noted. There is a focal left intraorbital haematoma.