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September 20-22, 2017 | Toronto, Canada
10
TH
AMERICAN PEDIATRICS HEALTHCARE &
PEDIATRIC INFECTIOUS DISEASES CONGRESS
Pediatric Healthcare & Pediatric Infections 2017
T
raumatic encephalocele following orbital roof blow in
fracture is a rare complication of blunt injury. Less than 20
such cases have been published till date. The term “blow-in”
fracture was initially coined by Dingman in 1964 describing
a specific fracture of the orbital floor and is now used to
describe a fracture of any orbital wall where the fragments
are intraorbitally displaced, as seen in our case. Clinical
suspicion, early neuroimaging and neurosurgical intervention
play a vital role to decrease both the intraorbital and
intracranial pressures and dreadful complications including
death, especially in pediatric population. We present a case
of a three years old female who sustained blunt head trauma
owing to vehicular accident. Due to the incident occurring at
a remote setting, the patient was brought to our institution
after three hours. Upon examination, the patient had a GCS
of 9, laceration in the right occipital area and proptosis,
chemosis and periorbital ecchimosis of the right side. Plain
cranial CT study revealed intra-parenchymal hemorrhage of
the left frontal lobe with subarachnoid and intra-ventricular
extension with surrounding diffuse cerebral edema and
rightward midline shift. A comminuted fracture of the right
medial and lateral orbital walls with displaced retrobulbar
bone fragments and partial herniation of the adjacent
frontal lobe displacing the intact right globe anterolaterally
was seen, with entrapment of the medial rectus muscle
and intact but stretched optic nerve. Even with the full
neurosurgical, radiological and pediatric team approaches,
the patient deteriorated and couldn’t be revived. A prompt
emergency ambulance service, timely clinical suspicion and
pediatric neuroimaging for detection of the encephalocele
and neurosurgical intervention have utmost importance in
such “ticking time bomb” cases. Traumatic blow in fracture
with encephalocele, a rare clinical entity, if caught early,
can still be managed as shown in the literatures with early
tertiary care intervention.
Speaker Biography
Ghimire Pradesh has completed his MBBS from Manipal College of Medical Sciences
affiliated to Kathmandu University, Nepal. He is a third year Radiology Resident in Bicol
Medical Center affliliated to Bicol University, Philippines
e:
pradeshpg@gmail.comAcute traumatic blow in fracture of orbital roof with transorbital encephalocele: A rare case report
Ghimire Pradesh, Collao M
and
Bista N
Bicol Medical Center, Philippines