Traumatic Brain Injury, Bulging Eyeball, and Skin Lumps

• Published in: World neurosurgery Vol. 168; pp. 207 - 208
• Main Authors: Yu, Qun, Zhu, Junming, Wu, Hemmings
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: Adult; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - surgery; Humans; Magnetic Resonance Imaging; Male; Neurofibromatosis 1 - surgery; Neurofibromatosis type 1; Orbit - surgery; Sphenoid wing dysplasia; Tomography, X-Ray Computed; Traumatic brain injury; Traumatic ocular injury; Sphenoid wing dysplasia; Neurofibromatosis type 1; Traumatic brain injury; Traumatic ocular injury; GCS
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.09.093

A 43-year-old man was admitted to the emergency department for motor vehicle collision. First clinical impression was traumatic injury of the right eye with bare light perception. A physical examination revealed multiple nodular skin lesions on the head and neck. Head magnetic resonance imaging and computed tomography scans showed intracerebral hemorrhage, trans-orbital brain herniation, and right sphenoid wing dysplasia. A diagnosis of neurofibromatosis type 1 was made. Sphenoid wing dysplasia (also known as bare orbit sign) in neurofibromatosis type 1 was a contributing factor to the trans-orbital herniation, but also helped reduce intracranial pressure after traumatic brain injury in this rare case. Mannitol was administered, and no neurosurgical intervention was needed for traumatic brain injury. Canthorrhaphy of the right eye was performed to preserve patient's right eyeball. At 1-month follow-up, patient's right eyeball was preserved, and vision improved as well.