Transorbital intracranial penetrating injury-an anatomical classification

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.

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.

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.