Pneumocephalus and presumed meningitis following inconspicuous penetrating periocular trauma.

Acta ophthalmologica Scandinavica

PubMedID: 15453862

Detorakis ET, Drositis I, Drakonaki EE, Panayotaki E, Deville JG. Pneumocephalus and presumed meningitis following inconspicuous penetrating periocular trauma. Acta Ophthalmol Scand. 2004;82(5):603-5.
PURPOSE
To report a case of serious intracranial complications in an adolescent youth following a seemingly trivial periocular injury.

METHODS
An adolescent youth was examined and discharged after a small penetrating injury to his left medial canthus. He later presented with blurred vision, nausea and mild pyrexia and underwent a computed tomography (CT) scan of the head and orbits as well as a lumbar puncture.

RESULTS
The CT scan revealed a fracture in the cribriform plate of the ethmoid bone and the medial orbital wall, as well as pneumocephalus. The lumbar puncture revealed 3000 white cells/mm3 in the cerebrospinal fluid (CSF). After treatment with meningitic doses of intravenous antibiotics, a significant improvement was noted.

CONCLUSIONS
A CT scan, instead of an ordinary head radiograph, may be considered as a first-choice mode of diagnosis in evaluating even inconspicuous penetrating periocular wounds. Early administration of meningitic doses of antibiotics may significantly improve prognosis.