Turbin et al studied penetrating transorbital injuries causing intracranial injury. They identified reasons why associated intracranial injuries could be missed. The authors are from the University of Medicine and Dentistry and Hackensack University Medical Center in New Jersey.


Risk factors for failure to diagnose intracranial injury following a penetrating transorbital injury:

(1) cursory exam

(2) innocuous looking wound with little bleeding

(3) occult injury (sparing the globe, optic nerve and other key structures)

(4) lack of neurologic signs and symptoms

(5) failure to get imaging studies

(6) failure to have adequate followup


Potential complications of a penetrating injury include:

(1) cerebral laceration

(2) hematoma or subarachnoid hemorrhage

(3) pyogenic abscess

(4) meningitis

(5) encephalitis

(6) pseudoaneurysm

(7) hemiplegia

(8) carotid-cavernous sinus fistula

(9) persistent CSF leakage


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