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Long term follow up after transorbital penetrating injury: A case report.
Am J Ophthalmol Case Rep. 2020 Sep; 19:100792.AJ

Abstract

Purpose

Traumatic brain injury is the leading cause of mortality and disability among young individuals. Unfortunately, there are few publications concerning long term follow up of patients with these types of injuries. We present a case of trans-orbital penetrating brain injury with an 18 year follow up.

Observations

A 43-year-old, previously healthy, male was accidently impaled on a fencing foil resulting in a penetrating brain injury. Initial symptoms included diplopia, ophthalmoparesis, a non-reactive pupil, decreased visual acuity, decreased sensation across the cheek, dysphagia and dysarthria. CT scan taken on presentation showed a clear tract of the foil traversing the various structures of the brain. One week after the trauma, the patient developed a unique constellation of paroxysmal attacks of autonomic dysfunction consisting of profuse diaphoresis and decreased skin temperature on the left side of the body, as well as dilation of the left pupil. Three months after the accident, the patient suddenly experienced severe constant pain affecting the left side of his body associated with thermal and tactile allodynia. On latest follow up, 18 years after the accident, the patient continues to have chronic pain, allodynia, and lack of temperature sensation throughout the left face, arm, and leg. He has a wide based, hemi-ataxic gait, with the left leg swinging out and around. EMG and nerve conduction studies have found no voluntary activity in the temporalis and masseter muscles resulting in atrophy and fibrosis. An MRI shows linear encephalomalacia along the path of the foil extending to the pons, involving the right spinothalamic tract, and cerebellum.

Conclusions and Importance

Our case illustrates the importance of such a longitudinal follow up. It demonstrates the possible severity of the sequelae from these types of injuries including chronic pain and gait ataxia, as well as EOM and autonomic dysfunction. Due to the potential ongoing needs of such patients, it is important to plan a long-term, team-based approach that centers around physical therapy and improving long term quality of life.

Authors+Show Affiliations

University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Veterans Affairs Medical Center, Boise, ID, USA.Mayo Clinic Arizona, Pheonix, AZ, USA.University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32642597

Citation

Vloka, Caroline, et al. "Long Term Follow Up After Transorbital Penetrating Injury: a Case Report." American Journal of Ophthalmology Case Reports, vol. 19, 2020, p. 100792.
Vloka C, Vloka A, Rath T, et al. Long term follow up after transorbital penetrating injury: A case report. Am J Ophthalmol Case Rep. 2020;19:100792.
Vloka, C., Vloka, A., Rath, T., & Stefko, S. (2020). Long term follow up after transorbital penetrating injury: A case report. American Journal of Ophthalmology Case Reports, 19, 100792. https://doi.org/10.1016/j.ajoc.2020.100792
Vloka C, et al. Long Term Follow Up After Transorbital Penetrating Injury: a Case Report. Am J Ophthalmol Case Rep. 2020;19:100792. PubMed PMID: 32642597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long term follow up after transorbital penetrating injury: A case report. AU - Vloka,Caroline, AU - Vloka,Alexander, AU - Rath,Tonya, AU - Stefko,Susan, Y1 - 2020/06/24/ PY - 2020/01/29/received PY - 2020/06/01/revised PY - 2020/06/20/accepted PY - 2020/7/10/entrez PY - 2020/7/10/pubmed PY - 2020/7/10/medline KW - Autonomic dysfunction KW - Central pain syndrome KW - Penetrating brain injury KW - Traumatic brain injury SP - 100792 EP - 100792 JF - American journal of ophthalmology case reports JO - Am J Ophthalmol Case Rep VL - 19 N2 - Purpose: Traumatic brain injury is the leading cause of mortality and disability among young individuals. Unfortunately, there are few publications concerning long term follow up of patients with these types of injuries. We present a case of trans-orbital penetrating brain injury with an 18 year follow up. Observations: A 43-year-old, previously healthy, male was accidently impaled on a fencing foil resulting in a penetrating brain injury. Initial symptoms included diplopia, ophthalmoparesis, a non-reactive pupil, decreased visual acuity, decreased sensation across the cheek, dysphagia and dysarthria. CT scan taken on presentation showed a clear tract of the foil traversing the various structures of the brain. One week after the trauma, the patient developed a unique constellation of paroxysmal attacks of autonomic dysfunction consisting of profuse diaphoresis and decreased skin temperature on the left side of the body, as well as dilation of the left pupil. Three months after the accident, the patient suddenly experienced severe constant pain affecting the left side of his body associated with thermal and tactile allodynia. On latest follow up, 18 years after the accident, the patient continues to have chronic pain, allodynia, and lack of temperature sensation throughout the left face, arm, and leg. He has a wide based, hemi-ataxic gait, with the left leg swinging out and around. EMG and nerve conduction studies have found no voluntary activity in the temporalis and masseter muscles resulting in atrophy and fibrosis. An MRI shows linear encephalomalacia along the path of the foil extending to the pons, involving the right spinothalamic tract, and cerebellum. Conclusions and Importance: Our case illustrates the importance of such a longitudinal follow up. It demonstrates the possible severity of the sequelae from these types of injuries including chronic pain and gait ataxia, as well as EOM and autonomic dysfunction. Due to the potential ongoing needs of such patients, it is important to plan a long-term, team-based approach that centers around physical therapy and improving long term quality of life. SN - 2451-9936 UR - https://www.unboundmedicine.com/medline/citation/32642597/Long_term_follow_up_after_transorbital_penetrating_injury:_A_case_report L2 - https://linkinghub.elsevier.com/retrieve/pii/S2451-9936(20)30128-6 DB - PRIME DP - Unbound Medicine ER -
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