Intracranial transorbital injury by a wooden foreign body: re-evaluation of CT and MRI findings

Abstract

Despite modern radiological imaging, a transorbital intracranial injury with a wooden foreign body can present a vexing diagnostic problem. The orbit forms an easy path for low-velocity foreign bodies into the intracranial space. Often the severity of the injury is masked by unobtrusive superficial wounds and lack of a primary neurological deficit. Misinterpretation of CT findings may delay adequate treatment, whereas MRI is more sensitive and specific. However, MRI T1-W can demonstrate an isointense or even hyperintense signal. Findings after the use of MRI contrast medium are presented and the diagnostic features of CT and MRI are reviewed. Two cases of such injury are presented.

Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience

“…On T-1 images, the IOWFB is hypointense from surrounding soft tissue, independent of its hydration, although this is not a uniform finding and ring enhancement with gadolinium may be seen initially in some cases. [15,16] In our series, in line with these recommendations, we needed MRI images for only two patients at the beginning of the study. As the radiologist's experience increased, CT images were adequate.…”

A retained wood penetrating the superior orbital fissure in a neurologically intact child

“…These findings in children can be supported by case reports in relevant literature (Table I). The most common characteristics of five cases on initial neurological examinations were accompanied by serious cranial nerve palsies (2,3,5,7,10). Only an asymptomatic case was immediately operated after penetrating transorbital intracranial injury(4), whereas in the present case, the patient is only a child who is neurologically intact despite a delayed admission.…”

“…The orbit is in the shape of a horizontal pyramid on a posteromedial axis and forms an easy path for low velocity foreign bodies into the intracranial space (2,7,10). This shape tends to deflect objects entering the orbit toward the apex where the superior orbital fissure and optic foramen may provide a passage to the intracranial contents (2,10).…”

Orbitocranial penetrating injury by a metallic foreign body. Case report and anatomical considerations

“…B). Two important anatomical characteristics make the orbit vulnerable to OPI: 1. the pyramid shape which makes that penetrating objects to be directed towards the apex, and SOF, IOF (posterior portion) and OC (35) allowing the passage to the middle cranial fossa and 2. thin walls, which make the orbit the most vulnerable structure of the skull (3).…”