Transorbital orbitocranial penetrating injuries (TOPIs) are relatively rare, can be caused by high-speed projectile foreign bodies to low-energy trauma (which is rarer), and account for 24% of penetrating head injuries in adults and approximately 45% in children. We report an uncommon nonfatal case of TOPI where a 16-year-old male child sustained injury due to accidental penetration of metal bar into the forehead. A bicoronal flap was raised to remove the metal bar. The patient recovered well, had normal vision, and doing well at follow-up.

Lateral meningocoele is a very rare disorder characterized by extensions of the dura and arachnoid through an enlarged neural foramen. We report a case of a 23-year-old female with deformity of spine who presented with low back pain and no neurological deficits. A whole spine magnetic resonance imaging showed multiple well-defined cystic masses involving dorsal, lumbar, and sacral spinal levels bilaterally, with dural ectasia and neural foraminal widening suggestive of bilateral multiple level lateral meningocoele. The patient is being managed conservatively and is on regular follow-up.

No abstract

Cavernous sinus thrombosis (CAST) is a rare and potentially fatal complication following tooth extraction. In present case of a 55 year old male known case of diabetes mellitus underwent tooth extraction. After 5 days, he noticed swelling around the cheek, high grade fever, and frontal headaches. Diagnosis of alveolar abscess after inspection was made, for which incision and drainage was done. Next morning, he noticed that the cheek swelling progressed to left eye and there was CT brain was performed which showed hyperdense areas in cavernous sinus on left side and left sylvian fissure with hemorrhagic venous infarct in left temporal and frontal lobes. More caudal sections revealed mucosal thickness in left maxillary and ethmoidal sinuses, edema over cheek, preseptal orbital swelling, retro-orbital fat stranding and axial proptosis. A diagnosis of rhino-orbital infection from dental source with cavernous sinus extension causing left temporo-frontal hemorrhagic venous infarction was made Emergency surgery for decompression was performed but the patient did not responded to the treatment and succumbed to the infection. This case is a reminder that in patients with uncontrolled diabetes, undergoing dental procedures should be carefully dealt with appropriate antibiotic cover. Early signs like unilateral facial edema, orbital chemosis, edema, and proptosis should raise high index suspicion of cavernous

Encephaloceles are rare embryological mesenchymal developmental anomalies resulting from inappropriate ossification in skull through with herniation of intracranial contents of the sac. Encephaloceles are classified based on location of the osseous defect and contents of sac. Convexity encephalocele with osseous defect in occipital bone is called occipital encephalocele. Giant occipital encephaloceles can be sometimes larger than the size of baby skull itself and they pose a great surgical challenge. Occipital encephaloceles (OE) are further classified as high OE when defect is only in occipital bone above the foramen magnum, low OE when involving occipital bone and foramen magnum and occipito-cervical when there involvement of occipital bone, foramen magnum and posterior upper neural arches. Chiari III malformation can be associated with high or low occipital encephaloceles. Pre-operatively, it is essential to know the size of the sac, contents of the sac, relation to the adjacent structures, presence or absence of venous sinuses/vascular structures and osseous defect size. Sometimes it becomes imperative to perform both CT and MRI for the necessary information. Volume rendered CT images can depict the relation of osseous defect to foramen magnum and provide information about upper neural arches which is necessary in classifying these lesions.