Orbital Apex Syndrome and Carotid Artery Injury Associated with Transorbital Stab Injury

Laurent Dimitri,Corlis Brian,Murad Gregory Ja

doi:10.23937/2643-4474/1710049

Abstract

Transorbital penetrating injuries are particularly rare in the adult population. We present a case of TOPI sustained in an assault using a ballpoint pen-with concomitant transmaxillary injury due to a pencil stab wound-and a review of the literature.

Highlights

We present a case of Transorbital penetrating injuries (TOPI) sustained in an assault using a ballpoint pen-with concomitant transmaxillary injury due to a pencil stab wound-and a review of the literature
In the setting of TOPI, there should be a high index of suspicion for damage to the intracranial vascular and neural structures
Transorbital penetrating injuries (TOPI) are rare in the adult population, accounting for 0.096% of all head injuries [1,2,3,4]

Summary

Introduction

Transorbital penetrating injuries (TOPI) are rare in the adult population, accounting for 0.096% of all head injuries [1,2,3,4]. A computed tomography angiography (CTA) scan of the head demonstrated the pen entering the right medial orbit, extending intracranially through the superior orbital fissure along the lateral wall of the right cavernous sinus, and terminating supratentorially in the right temporal lobe (Figure 2A and Figure 2B). Post-operatively, he was admitted to the neurosurgical intensive care unit and started on intravenous ampicillin/sulbactam He had persistent right sided ophthalmoplegia with ptosis, and complete loss of light perception in the right eye. There was some edema of the right cerebral hemisphere, with about four millimeters of midline shift He remained in ICU for about 24 hours before being transferred to the general trauma ward. The patient was scheduled for repeat head CT three months postoperatively, but refused imaging He was seen in the neurosurgery clinic 16 weeks after surgery complaining of new onset left sided visual loss. He was referred to neuro ophthalmology for further management of his visual complaints, but was lost to follow-up

Discussion

Findings

Figure 4