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Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 3  |  Page : 883-884

Eye in the brain


1 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Asha Brain and Spine Centre, Aligarh, Uttar Pradesh, India

Date of Web Publication15-May-2018

Correspondence Address:
Dr. Manjul Tripathi
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.232284

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How to cite this article:
Tripathi M, Varshney N, Batish A, Mohindra S. Eye in the brain. Neurol India 2018;66:883-4

How to cite this URL:
Tripathi M, Varshney N, Batish A, Mohindra S. Eye in the brain. Neurol India [serial online] 2018 [cited 2018 Aug 20];66:883-4. Available from: http://www.neurologyindia.com/text.asp?2018/66/3/883/232284




Orbital injury with secondary involvement of the brain is a potentially serious condition demanding urgent surgical repair. Neglected injuries may present with complications leading to significant morbidity such as cerebrospinal fluid orbitorrhoea, tension pneumocephalus, carotid cavernous fistulas, intracranial hematoma, subperiosteal orbital hematoma, orbital encephalocele, blepharocele, and vision loss.[1],[2],[3],[4],[5] However, posttraumatic globe herniation inside anterior cranial fossa is an unreported complication, which would need immediate repair.

A 5-year old girl was brought to the emergency department following a road traffic accident. On examination, she was drowsy and did not cooperate for visual evaluation because of painful periorbital edema [Figure 1]a. CT scan of the head revealed right orbital roof fracture with complete herniation of eyeball inside the anterior cranial fossa beneath the right frontal lobe [Figure 1]b with significant periglobal edema. Magnetic resonance imaging (MRI) of the brain revealed the herniated eyeball [Figure 1]c and [Figure 1]d and injury to the right optic nerve [Figure 1]c and [Figure 1]d. The parents did not consent for a transcranial surgery despite being explained the risks and prognosis of the conservative management and left against medical advice.
Figure 1: (a) Posttraumatic multiple facial injuries with periorbital edema; (b) computed tomography coronal image showing the eyeball in the anterior cranial fossa beneath the right frontal lobe; magnetic resonance axial (c), and sagittal image (d), showing the herniated eyeball beneath the right frontal lobe with surrounding edema

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Orbital roof fractures after blunt craniofacial injuries are uncommon entities. These fractures usually lead to orbital encephalocele, causing raised intracranial pressure (ICP) and optic nerve damage.[1],[2],[3],[4],[5] Decompression of the orbital roof with bony reconstruction avoids transmission of raised ICP inside the orbit. This case is the first of its kind as the entire globe had herniated inside the brain following a blunt injury to the eye. The possible pathophysiology might be sudden rise in intraorbital pressure following blunt injury to the eye. An associated bony fracture or congenital defect at the skull base may facilitate the reverse herniation of the eye inside the cranial compartment.

Although the eye cannot be salvaged in such a case, early surgical intervention is warranted to prevent secondary insults in the form of intracranial hematoma, edema, and sympathetic ophthalmitis. This case highlights the need for the organisation of social security services in every hospital, which may help in counselling of the parents, to facilitate treatment of the patients (especially in the case of minor children or unconscious patients), who cannot take decisions for their treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rao TN, Purohit AK, Dilnawaz, Murthy TV, Dinakar I. CSF orbitorrhoea with tension pneumocephalus. Neurol India 1999;47:65.  Back to cited text no. 1
[PUBMED]    
2.
Massenburg BB, Veetil DK, Raykar NP, Agrawal A, Roy N, Gerdin M. A systematic review of quantitative research on traumatic brain injury in India. Neurol India 2017;65:305-14.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Satyarthee GD, Borkar SA, Tripathi AK, Sharma BS. Transorbital penetrating cerebral injury with a ceramic stone: Report of an interesting case. Neurol India 2009;57:331-3.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Kataria R, Kumar V, Mehta VS. Traumatic bilateral orbital subperiosteal hematoma with vision loss. Neurol India 2010;58:495-7.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Mishra A, Gupta DK, Gamangatti S, Sharma BS. Post-traumatic blepharocele: A rare manifestation of head injury. Neurol India 2014;62:568-70.  Back to cited text no. 5
[PUBMED]  [Full text]  


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