J Korean Neurosurg Soc.  2012 Oct;52(4):414-416. 10.3340/jkns.2012.52.4.414.

Transorbital Penetrating Intracranial Injury by a Chopstick

• Shin TH
• Kim JH
• Kwak KW
• Kim SH

• KMID: 2190663
• DOI: http://doi.org/10.3340/jkns.2012.52.4.414

Abstract

A 38-year-old man fell from a chair with a chopstick in his hand. The chopstick penetrated his left eye. He noticed pain, swelling, and numbness around his left eye. On physical examination, a linear wound was noted at the medial aspect of the left eyelid. Noncontrast computed tomography (CT) study showed a linear hypodense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body. This foreign body was hyperdense relative to normal parenchyma. From a CT scan with 3-dimensional reconstruction, the foreign body was found to be passing through the optic canal into the cranium. The clear plastic chopstick was withdrawn without difficulty. The patient was discharged home 3 weeks after his surgery. A treatment plan for a transorbital penetrating injury should be determined by a multidisciplinary team, with input from neurosurgeons and ophthalmologists.

Keyword

Penetrating; Foreign body; Orbit; Craniocerebral trauma

MeSH Terms

Adult
Craniocerebral Trauma
Eye
Eyelids
Foreign Bodies
Hand
Humans
Hypesthesia
Occipital Bone
Orbit
Physical Examination
Plastics
Skull
Plastics

Figure

• 

  Fig. 1 The remarkably swollen left eyelid and a small laceration at upper medial epicanthal area of the left eye are presented.

• 

  Fig. 2 A, B and C : A noncontrast CT study shows a linear hyperdense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body that was hyperdense relative to normal parenchyma. D and E : A CT scan with 3-dimensional reconstruction shows foreign body going through the optic canal into the cranium.

• 

  Fig. 3 Intraoperative photograph shows the plastic chopstick, at about 14 cm in length. Chopstick was removed surgically.

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  Fig. 4 A : Axial T2-weighted MR image shows a hyperintense linear lesion injury from a chopstick. B : CISS image revealed that left facial nerve was not injured. MR : magnetic resonance, CISS : constructive Interference in Steady State.

Reference

1. Carothers A. Orbitofacial wounds and cerebral artery injuries caused by umbrella tips. JAMA. 1978; 239:1151–1152. PMID: 628067.

2. Chibbaro S, Tacconi L. Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients. Acta Neurochir (Wien). 2006; 148:937–941. discussion 941-942. PMID: 16763734.

3. De Villiers JC, Sevel D. Intracranial complications of transorbital stab wounds. Br J Ophthalmol. 1975; 59:52–56. PMID: 1125159.

4. Di Roio C, Jourdan C, Mottolese C, Convert J, Artru F. Craniocerebral injury resulting from transorbital stick penetration in children. Childs Nerv Syst. 2000; 16:503–506. discussion 507. PMID: 11007502.

5. du Trevou MD, van Dellen JR. Penetrating stab wounds to the brain : the timing of angiography in patients presenting with the weapon already removed. Neurosurgery. 1992; 31:905–911. discussion 911-912. PMID: 1436415.

6. Dunn IF, Kim DH, Rubin PA, Blinder R, Gates J, Golby AJ. Orbitocranial wooden foreign body : a pre-, intra-, and postoperative chronicle : case report. Neurosurgery. 2009; 65:E383–E384. discussion E384. PMID: 19625895.

7. Eidsness R, Coupal DJ, Kelly ME, Hattingh S. Traumatic orbital injury. J Trauma. 2007; 62:1286–1287. PMID: 17495739.

8. Fezza J, Wesley R. The importance of CT scans in planning the removal of orbital-frontal lobe foreign bodies. Ophthal Plast Reconstr Surg. 1999; 15:366–368.

9. Fujimoto S, Onuma T, Amagasa M, Okudaira Y. [Three cases of an intracranial wooden foreign body]. No Shinkei Geka. 1987; 15:751–756. PMID: 3670545.

10. Ginsberg LE, Williams DW 3rd, Mathews VP. CT in penetrating craniocervical injury by wooden foreign bodies : reminder of a pitfall. AJNR Am J Neuroradiol. 1993; 14:892–895. PMID: 8352161.

11. Hansen JE, Gudeman SK, Holgate RC, Saunders RA. Penetrating intracranial wood wounds : clinical limitations of computerized tomography. J Neurosurg. 1988; 68:752–756. PMID: 3357035.

12. Kahler RJ, Tomlinson FH, Eisen DP, Masel JP. Orbitocranial penetration by a fern : case report. Neurosurgery. 1998; 42:1370–1373. PMID: 9632198.

13. Kasamo S, Asakura T, Kusumoto K, Nakayama M, Kadota K, Atsuchi M, et al. [Transorbital penetrating brain injury]. No Shinkei Geka. 1992; 20:433–438. PMID: 1570067.

14. Kazarian EL, Stokes NA, Flynn JT. The orbital puncture wound : intracranial complications of a retained foreign body. J Pediatr Ophthalmol Strabismus. 1980; 17:247–250. PMID: 7411338.

15. Kitakami A, Kirikae M, Kuroda K, Ogawa A. Transorbital-transpetrosal penetrating cerebellar injury--case report. Neurol Med Chir (Tokyo). 1999; 39:150–152. PMID: 10193148.

16. Knerlich F, Verheggen R. Neurological picture. Feeding cats might be dangerous : penetrating orbital and brain injury without neurological deficits. J Neurol Neurosurg Psychiatry. 2005; 76:1359. PMID: 16170076.

17. Lunetta P, Ohberg A, Sajantila A. Suicide by intracerebellar ballpoint pen. Am J Forensic Med Pathol. 2002; 23:334–337. PMID: 12464807.

18. Maruya J, Yamamoto K, Wakai M, Kaneko U. Brain abscess following transorbital penetrating injury due to bamboo fragments--case report. Neurol Med Chir (Tokyo). 2002; 42:143–146. PMID: 11936059.

19. Matsumoto S, Hasuo K, Mizushima A, Mihara F, Fukui M, Shirouzu T, et al. Intracranial penetrating injuries via the optic canal. AJNR Am J Neuroradiol. 1998; 19:1163–1165. PMID: 9672032.

20. Miller CF, Brodkey JS, Colombi BJ. The danger of intracranial wood. Surg Neurol. 1977; 7:95–103. PMID: 835079.

21. Reddy HS, Chang E. Images in clinical medicine. Penetrating orbital trauma. N Engl J Med. 2008; 358:e3. PMID: 18199858.

22. Smely C, Orszagh M. Intracranial transorbital injury by a wooden foreign body : re-evaluation of CT and MRI findings. Br J Neurosurg. 1999; 13:206–211. PMID: 10616594.

23. Turbin RE, Maxwell DN, Langer PD, Frohman LP, Hubbi B, Wolansky L, et al. Patterns of transorbital intracranial injury : a review and comparison of occult and non-occult cases. Surv Ophthalmol. 2006; 51:449–460. PMID: 16950246.

24. Walid MS, Yelverton JC, Robinson JS Jr. Penetrating orbital trauma with internal carotid injury. South Med J. 2009; 102:116–117. PMID: 19077762.

25. Wesley RE, Anderson SR, Weiss MR, Smith HP. Management of orbital-cranial trauma. Adv Ophthalmic Plast Reconstr Surg. 1987; 7:3–26. PMID: 3502746.

26. Zentner J, Hassler W, Petersen D. A wooden foreign body penetrating the superior orbital fissure. Neurochirurgia (Stuttg). 1991; 34:188–190. PMID: 1775211.