Occult Intraorbital and Intracranial Wooden Foreign Body

A 63-year-old female presented to an outside hospital emergency department after a mountain biking accident with head trauma (Fig. 1A). On the initial trauma survey, no neurological deficits were documented. CT trauma series of the head unexpectedly revealed a large deeply penetrating linear foreign body through the medial right orbit and into the right temporal lobe (Fig. 1B,C). Imaging demonstrated a fracture of the lateral orbital apex and a subarachnoid hemorrhage. Emergency craniectomy was performed with the removal of a 12.5 cm × 1 cm wood stick (Fig. 1D), followed by external ventricular drain placement. Postoperative ophthalmic examination demonstrated light perception vision with a relative afferent pupillary defect, consistent with traumatic optic neuropathy OD. Persistent periorbital inflammation prompted repeat orbital imaging several weeks later, which demonstrated multiple intraconal and extraconal fluid collections extending to the orbital apex and new optic nerve enhancement (Fig. 2A,B). The patient was transferred to our institution, where emergent right temporal craniotomy and right orbitotomy were performed. Intraoperatively, several residual branch fragments were removed from the right orbit. At 3 months follow-up, the patient is ambulatory with partial short-term memory deficits, limitations in fine motor skills, and right hearing loss. The patient’s vision remains at light perception OD.FIG. 1.FIG. 2.