Transorbital Craniocerebral Occult Penetrating Injury with Cerebral Abscess Complication

Abstract

Transorbital intracranial penetrating injury is an uncommon mechanism of head injury. These injuries can be occult during the initial clinical presentation. Certain patients develop an intracranial cerebral infection. Herein, we report a 5-year-old child with an occult transorbital intracranial penetrating injury caused by a pen. A retained pen tip was found at the superior orbital roof and was not noticed at initial presentation. This was complicated by a right frontal lobe cerebral abscess. This paper emphasizes the importance of orbitocranial imaging in any penetrating orbital injury. A review of the literature on intracranial infection locations in relation to the route and mechanism of injury is included to complement this report.

Civilian Occult Orbitocranial Penetrating Injury Presenting with Cerebral Abscess in Elderly Patient

“…Penetrating injuries in civilian setup are uncommon. The various objects reported include pencil, 6 metal, 7 bicycle handle, 8 knife, 9 penetrating gunshot, 10 toothbrush, 11 and arrow. 12 Transorbital penetrating craniocerebral injuries are more common in the pediatric population as compared with adults and are very rare in the geriatric age group.…”

“…The authors have reviewed the cases of craniocerebral penetrating injuries and noticed their rarity in the elderly population. 6 The hard bony cranium protects the brain and prevents easy entry of foreign objects into the skull. However, there are certain weak points in the skull that allows easy entry of foreign objects.…”

“…A variety of complications such as orbital cellulitis, cerebral abscess, meningitis, delayed neurologic deterioration related to slowly expanding intracranial hematoma, and mortality have been reported due to delayed diagnosis. 5,6 Therefore, early recognition of foreign bodies by appropriate radiologic images can prevent life-threatening complication.…”

Impalement brain injury: report of five consecutive clinical cases

“…The poor outcome observed in our series (three cases of mortalities) was attributed to the severity of brain injury, as all the mortalities presented with Glasgow coma scale score of eight and below. However, the overall outcome of impalement injury depends on the site of injury and the extent of damage caused by the objects [11].…”

“…The outcome of cranio-cerebral injury depends on the site of injury, depth of penetration and severity of the damage caused by the impaled object [11,12]. Early diagnosis, prompt and adequate resuscitation and appropriate neurosurgical intervention is key to favourable outcome.…”