Cerebrospinal Fluid Blepharocele: An Unusual Complication of Head Injuries

Garza-Mercado, Román; Aragon-Lomas, Jorge; Martinez-Garza, Jesus; Leal-Hernandez, Luis

doi:10.1227/00006123-198210000-00012

Cited by 13 publications

(12 citation statements)

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“…Few authors have reported on cranio-orbital fistulas in which the CSF has remained entrapped within the orbit as orbitocele 25 or in the soft tissues of the eyelid (blepharocele). 11,12,25 The differential diagnosis of these orbital masses should include retrobulbar hematoma, orbital abscess, mucocele, or foreign body cyst. 14,30 In patients with pulsating exophthalmus and local bruit, especially in the presence of ecchymosis, which is common after direct or penetrating orbital injury, cerebral angiography should be performed to exclude the possibility of a carotid-cavernous fistula.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of posttraumatic oculorrhea

Salame¹,

Segev²,

Fliss³

et al. 2000

FOC

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Posttraumatic cranio-orbital cerebrospinal fluid (CSF) fistula is very rare. Diagnosis of these fistulas may be difficult, and it is possible that this complication of craniofacial injury is underdiagnosed. Early recognition and adequate treatment is of paramount importance to prevent hazardous complications. The authors report the case of a 20-year-old woman in whom a CSF leak developed through the medial canthus area of her eye after she sustained a mild sports-related injury. Clinical examination and chemical analysis of the fluid led to the correct diagnosis, and the leak was stopped with conservative treatment. It is proposed that a CSF leak through the eye be termed “oculorrhea” as compared with otorrhea and rhinorrhea. The mechanism of the fistula in this patient is discussed, as is the pertinent radiologically demonstrated anatomy and the mechanism of injury. Management and controversies are also discussed.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and management of posttraumatic oculorrhea

Salame¹,

Segev²,

Fliss³

et al. 2000

FOC

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“…Systematic review based on the MOOSE guidelines in MedLine, Embase and Lilacs using various combinations of the terms "orbital CSF fistula","cranioorbital fistula", "posttraumatic", "tbi". 36 studies were included for further analysis and 15 met the inclusion criteria for this review [3,16,13,12,20,10,22 Based on the speed of the penetrating head injury, these can be classified in high and low speed injuries [14]. This case describes an injury caused by a high speed and low temperature foreign object (wood), which caused the fracture in the left orbital cavity, crossed the ethmoidal sinus in the midline and immediately damaged the right optic nerve.…”

Section: Discussionmentioning

confidence: 99%

Persistent post-traumatic orbital cerebrospinal Fluid Fistula with multiple episodes of meningitis: Systematic Case Review and Case Report

Liem

Lisboa-Neto²,

Paschoal

et al. 2016

Int Arch Med

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Background: Orbital cerebrospinal fluid (CSF) fistulas are very rare. Most of these fistulas spontaneously heal within a couple of days and usually do not require surgical repair. Furthermore, they present low rates of complications. Case presentation: We report a case of a 15-year-old boy that suffered a penetrating head trauma and developed multiple episodes of meningitis due to a persistent orbital and nasal CSF fistula. He underwent multiple different procedures to correct the dural breach: sphenoidal endoscopic approach, and three craniotomies, the last one succeeded with the placement of autologous grafts and biological glue. A lumbar-subarachnoidal peritoneal shunt was placed to aid for 5 days. The CSF fistula ceased to drain and he recovered of the meningitis with additional standard antibiotics. Review: A systematic review in MedLine, Embase and Lilacs, identified 15 reported cases of persistent orbital CSF fistulas post-trauma. Traffic accidents were the most common mechanism of trauma. Most cases were reported in young boys and the main clinical manifestation was persistent "oculorrhea". The CSF leaks were traced with CT-scans and were predominantly managed surgically. No fatal outcomes were reported. Conclusion: The reported cases raise awareness for persistent orbital CSF fistulas. Early diagnosis and adequate management is crucial to prevent complications, which are rare, but can be highly morbid and fatal.

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“…To date, 10 cases of post-traumatic CSF oculorrhea have been reported (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). One patient developed increasing and pulsatile proptosis 1 week after a motor vehicle accident.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Leak Presenting as Oculorrhea After Blunt Orbitocranial Trauma

Apkarian¹,

Hervey-Jumper²,

Trobe³

2014

Journal of Neuro-Ophthalmology

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Cerebrospinal fluid (CSF) leak is an uncommon but well-documented occurrence after blunt head trauma, typically manifesting as otorrhea or rhinorrhea. Blunt cranio-orbital trauma also may cause CSF leak into the orbit, manifesting as orbitocele, blepharocele, chemosis, or tearing ("oculorrhea"). We report a patient who developed oculorrhea after blunt head trauma, and neuroimaging disclosed comminuted fractures of the left frontal, greater sphenoid wing, nasal, and maxillary bones. Because he also displayed chemosis and markedly reduced ocular ductions and periocular pain, carotid-cavernous fistula was suspected but appropriate vascular imaging was negative. Aspiration of subconjunctival fluid was positive for beta-2 transferrin, a specific marker for CSF. Chemosis lessened and the oculorrhea ceased spontaneously within 6 days of the trauma. This manifestation of CSF leak must not be overlooked because of the threat of meningitis.

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Cerebrospinal Fluid Blepharocele: An Unusual Complication of Head Injuries

Cited by 13 publications

References 0 publications

Diagnosis and management of posttraumatic oculorrhea

Diagnosis and management of posttraumatic oculorrhea

Persistent post-traumatic orbital cerebrospinal Fluid Fistula with multiple episodes of meningitis: Systematic Case Review and Case Report

Cerebrospinal Fluid Leak Presenting as Oculorrhea After Blunt Orbitocranial Trauma

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