Management of transorbital brain injury

Transorbital brain injuries caused by metal bar penetration are uncommon and often cause serious damage without prompt treatment. Artifacts caused by the penetrating metal bar on computed tomography (CT) often obscure the actual brain damage along the path of penetration, and delayed treatment for the brain insult may result. We present 2 cases of transorbital brain injury following penetration by a metal bar. CT scans were initially performed on both patients. However, image resolution was poor and the extent of brain damage could not be ascertained due to severe artifacts associated with the metal bars. Both patients deteriorated in the emergency room and subsequently received surgical intervention. One patient recovered uneventfully. Unfortunately, the other patient died following surgery due to an unrecognized intracranial hemorrhage with brain herniation. Based on this experience, we recommend prompt surgical decompression with early CT follow-up to determine the true extent of brain damage and assess for possible delayed events inpatients with extended transorbital brain injuries caused by metal bars.