Penetrating Orbitocranial Injury

• Main Authors: Marisa Klančnik, Petar Ivanišević, Slaven Lupi-Ferandin, Ante Sučić, Vlatko Ledenko, Mladen Lešin, Marina Krnić Martinić, Ljubica Kuščić-Juretić
• Format: Article
• Language: English
• Published: Sestre Milosrdnice University hospital, Institute of Clinical Medical Research 2018-01-01
• Series: Acta Clinica Croatica
• Subjects: Case reports; Head injuries, penetrating; Eye injuries, penetrating; Orbit; Brain edema
• Online Access: http://hrcak.srce.hr/file/318002
• ISSN: 0353-9466; 1333-9451

A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had sustained stab injury of the right orbit with penetration into the right frontal brain lobe. Multi-slice computed tomography (MSCT) showed penetrating injury and fracture of the right orbital roof without eyeball damage and endocranial impressed bone fragments into the right frontal brain lobe. Urgent surgical intervention was performed by a maxillofacial surgeon and neurosurgeon, including reposition of bone fragments of the orbital roof and cranioplasty. Reconstruction of Tenon’s capsule of the right eyeball was performed by an ophthalmologist. From the intraoperative wound swab of the orbit, Bacillus cereus was isolated, therefore the patient was administered ciprofloxacin and rifampicin as recommended by an infectious disease (ID) specialist. Follow up brain MSCT at 15 days and magnetic resonance imaging of the brain at 25 days showed brain edema in the right frontal area and signs of local brain abscess. Intravenous administration of the ciprofloxacin and metronidazole antibiotics with corticosteroids for edema suppression were ordered by the ID physician. Fourteen weeks after this therapy, brain MSCT showed complete abscess regression and no neurologic deficit with only mild psychomotor changes.