Transorbital intracranial penetrating injury-an anatomical classification

BACKGROUND: A transorbital intracranial injury with a wooden foreign body can be very difficult to diagnose and manage. The orbit forms an easy path for low-velocity foreign bodies into the intracranial space. The severity of the injury is often masked by unobtrusive superficial wounds. Computed tomography (CT) findings may be misinterpreted as pneumocephalus.

CASE DESCRIPTION: We present a young gentleman who had a fall under the influence of alcohol near a bush and, on clinical presentation, had very little signs of a penetrating injury in the skin. There was some numbness in the V1 distribution of the trigeminal nerve. Further investigation and management are described.

CONCLUSION: Although magnetic resonance imaging is more sensitive and specific, a CT angiogram with 3-dimensional reconstruction will provide much insight into the mode of intervention required. We present an anatomical classification for such injuries.