Transorbital Penetrating Intracranial Trauma with a Pen. A case Report

Abstract

Intracranial injury by penetrating foreign bodies through the eye socket is an unusual form of traumatic brain injury. Postoperative complications, such as meningitis, bleeding and brain abscess are some of the most common in these rare cases. In this study, we are reporting a case of a 54-year-old man who stuck a pen in his left eye socket with the aim of committing suicide. The patient arrived via emergency with clinical manifestations of hemiparesis and ophthalmoplegia, CT scan was performed which showed the presence of a foreign body (a writing pen) in the projection of the left orbit, the course of which crosses the apex of the orbit and the basal part of the brain (without displacement of medial structures) penetrating the upper part of the left cerebellar hemisphere. After successful extraction, the patient was in our neuro-intensive care unit for a period of 3 days. The patient was prescribed intravenous administration of broad-spectrum antimicrobials, but 5 days after the injury, developed secondary bacterial meningitis so it was decided to change the antibiotic therapy. After 12 days of admission, the patient presented a noticeable improvement while his relatives asked for discharge at their request and, 3 weeks later the patient is readmitted with symptoms of hydrocephalus. In the control CT, can be seen a marginal lamellar fracture in the apex of the left orbit, accompanied by purulent meningitis and post-traumatic occlusive hydrocephalus.