J Korean Soc Radiol.  2011 Nov;65(5):447-450.

Massive Subarachnoid Pneumocephalus due to Transorbital Intracranial Penetrating Injury: A Case Report

• Kwak SH
• Lee SY
• Cha SH
• Kang MH
• Cho BS
• Han GS
• Park KS
• Kim SJ

Abstract

A transorbital intracranial injury is a rare penetrating injury that can cause severe damage to orbital and cerebral structures. We report the case of a 53-year-old woman with massive subarachnoid pneumocephalus caused by a transorbital penetrating injury. She presented to our hospital with ocular pain after she accidently pierced her left eye with a steel wire while fixing a plant in a pot. A physical examination did not show any neurologic deficit. A brain CT showed a massive subarachnoid pneumocephalus with minimal intracranial hemorrhage and a 3D-reconstructed CT image showing a fracture at the pneumatized anterior clinoid process. A follow-up brain CT scan performed 10 days later revealed that the pneumocephalus and intracranial hemorrhage had completely resolved. The patient recovered without any complications.

MeSH Terms

Brain
Eye
Female
Follow-Up Studies
Humans
Intracranial Hemorrhages
Middle Aged
Neurologic Manifestations
Orbit
Physical Examination
Plants
Pneumocephalus
Steel
Steel

Figure

• 

  Fig. 1 A 53-year-old woman with a transorbital penetrating injury. A. Axial, coronal and sagittal brain CT images show massive disseminated subarachnoid pneumocephalus. Note the low attenuation air-bubbles in both lateral, 3rd and 4th ventricles. B, C. Reformatted oblique axial and sagittal images of facial bone CT show the portal of penetration. Bone defect and fractured fragment at orbital roof (arrow) and anterior clinoid process (arrowhead) are indicated. Air bubbles are shown along the penetration site of orbital fat. D. 3D reconstruction image shows fracture at left anterior clinoid process. Note the superiorly displaced fractured fragment (arrow). E. On the follow up brain CT after 10 days, pneumocephalus was completely disappeared.

Reference

1. Yildiz A, Duce MN, Ozer C, Apaydin FD, Eğilmez H, Kara E. Disseminated pneumocephalus secondary to an unusual facial trauma. Eur J Radiol. 2002; 42:65–68.

2. Paiva WS, Monaco B, Prudente M, Soares MS, de Amorim RL, de Andrade AF, et al. Surgical treatment of a transorbital penetrating brain injury. Clin Ophthalmol. 2010; 4:1103–1105.

3. Ha H, Kim YS, Seo JS, Lee WT. Homicidal transorbital intracranial injury by a metallic chopstick: a case report. Korean J Leg Med. 2007; 31:197–199.

4. 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.

5. Kozikowski GP, Cohen SP. Lumbar puncture associated with pneumocephalus: report of a case. Anesth Analg. 2004; 98:524–526.

6. Sherman SC, Bokhari F. Massive pneumocephalus after minimal head trauma. J Emerg Med. 2003; 25:319–320.

7. Babl FE, Arnett AM, Barnett E, Brancato JC, Kharasch SJ, Janecka IP. Atraumatic pneumocephalus: a case report and review of the literature. Pediatr Emerg Care. 1999; 15:106–109.

8. Yamashita T, Mikami T, Baba T, Minamida Y, Sugino T, Koyanagi I, et al. Transorbital intracranial penetrating injury from impaling on an earpick. J Neuroophthalmol. 2007; 27:48–49.

9. Kim S, Lee JY, Song JS, Oh J. Transorbital-intracranial injury by a chopstick: three-dimensional computed tomography. Acta Ophthalmol Scand. 2005; 83:609–610.