Presentation
Golf club shaft to face.
Patient Data
The pattern of injury is consistent with a penetrating injury through the orbit and into the brain with orbital fractures and a hemorrhagic tract seen.
The fracture is identified through the orbital apex extending into the lateral wall silhouette sinus are better appreciated on the recent CT facial bones. Stable proptosis. No MR evidence of injury to the globe.
A cylindrical region of signal dropout compatible with blood product extends back from the orbital apex lateral to the cavernous sinus, skimming the mesial temporal lobe and superior aspect of the right cerebellar hemisphere to terminate adjacent to the posterior free edge of the tentorium cerebelli representing the pathway of penetrating injury. There is surrounding high T2 signal and areas of cortical diffusion restriction and petechial hemorrhage surrounding the pathway within the mesial temporal lobe and superior right cerebellar hemisphere. The cerebral peduncle and pons are spared.
Thin layer of right sided subdural hematoma extends along the falx and right tentorium. Small right subdural convexity subdural hematoma. Trace of subarachnoid hemorrhage in right frontoparietal and left occipital sulci. Subarachnoid hemorrhage is present near the vertex. Hemorrhage is present in the occipital horn of the right lateral ventricle.
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