Transorbitary intracranial penetrating injury involving bicycle brake handle: case report and literature review

Abstract

ABSTRACT Penetrating cranio-orbital injuries are uncommon events and represent a small percentage of cranioencephalic traumas. The clinical condition and surgical management were described by reviewing the patient's electronic medical records. This case reports on a 37-year-old male patient who suffered penetrating trauma to the skull from the brake lever of his bicycle as a result of an accidental fall while cycling. Brought in by the SAMU, the patient had a Glasgow score of 15, a preserved left orbit, while the right orbit showed no eye opening, amaurosis, a non-photo-reagent mydriatic pupil, both to the direct and indirect reflex. A computed tomography scan of the skull showed a metal brake handle lodged in the skull on the right, causing a fracture of the orbital face of the zygomatic and greater wing of the sphenoid, with the end in the orbit. In the operating room, the object was carefully extracted without complications. On the first postoperative day, a magnetic resonance imaging scan was requested, which revealed a hemorrhagic contusion of the temporal lobe on the right side, rupture of the lateral rectus muscle, hematic and gaseous contents inside the orbit, as well as a possible retinal detachment. On the sixth post-operative day, with amaurosis maintained on the right, the patient was discharged and referred for specialized ophthalmological follow-up. Penetrating cranio-orbital trauma has potentially fatal outcomes if not diagnosed and managed early and properly.

Keywords

• Head injuries, penetrating
• Orbit
• Blindness
• Retinal detachment
• Orbital fractures
• Cyclist
• Bicycling
• Magnetic resonance imaging