Fatal orbital penetrating injury complicated by contralateral internal carotid artery thrombosis and fungal meningitis: A case report

Intracranial extension of orbital penetrating injuries is extremely rare and often leads to life-threatening complications, especially when vascular events and opportunistic infections are involved. We report the case of a 25-year-old male who suffered a left orbital injury with a wooden stick during a motorcycle accident. The stick traversed the left orbit, reached the right cavernous sinus, and terminated near the prepontine cistern, causing bilateral vision loss and right internal carotid artery thrombosis. It was removed endoscopically. Postoperatively, the patient developed fungal meningitis due to Aspergillus and was treated with systemic voriconazole. Though discharged in stable condition, he died at home two months later, likely from fungal vasculitis due to subtherapeutic antifungal levels. This case highlights the challenges in managing orbital injuries with intracranial extension, especially when organic foreign bodies are involved. These carry a high risk for fungal infection due to their porous nature. Early surgical intervention, antifungal therapy, and long-term drug level monitoring are essential to reduce the risk of delayed, fatal complications. Coordinated multidisciplinary management, prompt debridement, antifungal prophylaxis, and ongoing follow-up are critical to improving outcomes in such complex cases.