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      Transorbital Craniocerebral Penetration by a Sharp Object with an Intact Globe

      case-report
      1 , , 2 , , 1 ,
      Case Reports in Emergency Medicine
      Hindawi

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          Abstract

          Traumatic eye injuries are common in children and are mostly superficial. Vigilance must always be practiced when examining these children to avoid missing any hidden serious injuries that may result in devastating complications. We describe the acute and definitive management of a child treated 17 h after transorbital craniocerebral penetration by a sharp object. Despite the rarity of these types of injury, a good outcome can be achieved if they are promptly recognized and managed.

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          Most cited references17

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          Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases.

          The authors present an illustrative case of occult transorbital penetrating intracranial injury in a child, and review the literature concerning patterns of low-velocity, non-projectile injury during the era of modern CT and MRI study. Review of the mechanism of injury and analysis of surface entry site of penetration in 38 cases suggests recurring patterns of injury in occult and non-occult cases. A classification system based on surface entry zone site is applied to these injuries. Knowledge of the classification system should increase clinical suspicion for this type of often occult, penetrating orbito-cranial injury and direct appropriate investigation to provide earlier detection and diagnosis of the transorbital, intracranial penetration.
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            The danger of intracranial wood.

            Peri-orbital puncture wounds by sharp wooden objects are not rare, but can be dangerous when there is intracranial penetration by and retention of the wooden foreign body. Days to years after an apparently trivial initial wounding, serious intracranial complications can occur. The authors have reviewed 42 case reports from the literature. Morbidity-defined as permanent neurologic sequelae-occurred in 74% of the cases. Intracranial suppuration was the major complication, with brain abscess having occurred in nearly one-half of the cases. Mortality occurred in 25% of 28 cases occurring in the post-antibiotic era. The qualities of wood which make it especially hazardous as a wounding agent and foreign body are discussed. The role of orbital anatomy in affording easy access to the cranial contents is described. Surgical exploration in all those cases in which there is a reasonable suspicion of intracranial injury is recommended.
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              Management of transorbital brain injury.

              Transorbital brain injuries caused by metal bar penetration are uncommon and often cause serious damage without prompt treatment. Artifacts caused by the penetrating metal bar on computed tomography (CT) often obscure the actual brain damage along the path of penetration, and delayed treatment for the brain insult may result. We present 2 cases of transorbital brain injury following penetration by a metal bar. CT scans were initially performed on both patients. However, image resolution was poor and the extent of brain damage could not be ascertained due to severe artifacts associated with the metal bars. Both patients deteriorated in the emergency room and subsequently received surgical intervention. One patient recovered uneventfully. Unfortunately, the other patient died following surgery due to an unrecognized intracranial hemorrhage with brain herniation. Based on this experience, we recommend prompt surgical decompression with early CT follow-up to determine the true extent of brain damage and assess for possible delayed events inpatients with extended transorbital brain injuries caused by metal bars.
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                Author and article information

                Contributors
                Journal
                Case Rep Emerg Med
                Case Rep Emerg Med
                CRIEM
                Case Reports in Emergency Medicine
                Hindawi
                2090-648X
                2090-6498
                2018
                21 March 2018
                : 2018
                : 3575897
                Affiliations
                1Pediatric Emergency Department, King Fahd Medical City, Riyadh, Saudi Arabia
                2Ophthalmology Department, King Fahd Medical City, Riyadh, Saudi Arabia
                Author notes

                Academic Editor: Aristomenis K. Exadaktylos

                Author information
                http://orcid.org/0000-0001-8701-4402
                http://orcid.org/0000-0002-1440-7253
                http://orcid.org/0000-0001-5386-1021
                Article
                10.1155/2018/3575897
                5884235
                f5c53660-53ba-4635-be68-4afa40d9e824
                Copyright © 2018 Abdullelah A. Alamri et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 6 November 2017
                : 27 January 2018
                : 5 February 2018
                Categories
                Case Report

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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