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Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia

Parthak Prodhan1, Natan N Noviski, William E Butler

  • 1Department of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 2, 2003
PubMed

Insights

Orbital compartment syndrome can mimic brain herniation in children with traumatic asphyxia. Prompt recognition and treatment with lateral canthotomies are crucial for preserving vision in these critical cases.

Area of Science:

  • Ophthalmology
  • Pediatric Critical Care
  • Trauma Surgery

Background:

  • Traumatic asphyxia syndrome (TAS) is a rare but severe condition resulting from blunt chest trauma.
  • TAS can lead to significant morbidity and mortality due to prolonged hypoxemia and systemic complications.
  • Orbital compartment syndrome (OCS) is a surgical emergency characterized by increased intraorbital pressure, potentially leading to vision loss.

Observation:

  • A 12-year-old boy with severe TAS presented with signs mimicking cerebral herniation, including bilateral pupillary dilation and unresponsiveness to light.
  • Ophthalmologic examination revealed bilateral OCS as the cause of the pupillary abnormalities.
  • The patient had experienced prolonged hypoxemia and massive capillary leak syndrome secondary to TAS.

Findings:

  • Emergent bilateral lateral canthotomies were performed at the bedside.
  • The procedure resulted in a prompt return of pupillary size and reactivity and a decrease in intraocular pressure.
  • The patient achieved complete visual recovery in the right eye but had severe impairment in the left eye.

Implications:

  • This case highlights the critical importance of considering OCS in pediatric patients with TAS presenting with altered pupillary function.
  • Early recognition and surgical intervention (lateral canthotomy) for OCS in TAS can prevent irreversible vision loss.
  • Clinicians should maintain a high index of suspicion for OCS in patients with severe blunt chest trauma and associated neurological or pupillary changes.
Abstract

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