Non-Surgical Management and Partial Recovery of a 19-Year-Old with Low-Speed Transorbital Penetrating Brain Injury

Background: Clinical management of intracranial transorbital penetrating injury (TOPI) is challenging and may require surgery. Both the trauma and surgery can result in neurovascular damage, bleeding, and infection. Low-speed injury may involve the superior orbital fissure (SOF) as the main point of entry into the skull and is associated with lower morbidity than high-speed injuries. This report describes a 19-year-old man with pontine and left cerebellar involvement from a TOPI with partial recovery without surgery.
Case Report: We hereby report the case of a 19-year-old man who underwent a low-speed in-out (as the foreign body was immediately retrieved) deep transorbital pontine and left cerebellar penetrating injury. Despite transient loss of consciousness, his Glasgow Coma Scale at admission was 15. An intravenous antibiotic regimen was rapidly initiated. He had ophthalmic (V1) et maxillary (V2) nerves palsy, minor right pyramidal syndrome, and left
kinetic cerebellar syndrome. Multi-modal imaging perfectly correlated with the clinical presentation. Neither surgical nor angiographic management was required. Clinical evolution was favorable, and the patient partially recovered.
Conclusions: In case of penetration through the SOF, the clinical course tends to be benign. However, this case should not overshadow potential life-threatening complications of TOPIs. This report highlights the importance of a multi-disciplinary approach for the diagnosis and management of traumatic transorbital penetrating intracranial injury. As illustrated, medical imaging may demonstrate the exact pathway of the offending object.