Ophthalmoplegia associated with transorbital penetrating brainstem injury by broken fishing pole

Abstract

We report our findings in a case of ophthalmoplegia caused by a transorbital penetrating brainstem injury. An 8-year-old boy was accidentally injured by a broken fishing fiberglass pole which penetrated through the right orbit and entered the brainstem. Magnetic resonance imaging showed a linear wound that entered and passed through the pons obliquely and reached the fourth cerebral ventricle and cerebellar vermis. He had a left-sided hemiplegia and left facial nerve palsy and was diagnosed with "one-and-a-half syndrome". His hemiplegia and left facial nerve palsy resolved in 2 weeks leaving only a left abducens nerve palsy. The eye position and eye movements fully recovered within 3 months. These findings suggest a good prognosis for this type of trauma unless life-threatening changes develop.

Keywords: penetrating orbitocranial injury; penetrating orbitocranial trauma; trauma.

Figure 1

Magnetic resonance image showing a linear wound (indicated by white arrows) that traverses the pons and reaches the fourth cerebral ventricle and cerebellar vermis.

Figure 2

External photograph of the eyes, and Hess chart, at the initial examination. (A) Esotropia can be seen at the primary eye position. Abduction of the left eye is severely impaired, and adduction is mildly limited in both eyes (indicated by arrows). (B) Hess chart shows esotropia and limitation of abduction of the left eye.

Figure 3

External photograph of the eyes, and Hess chart, three months after the injury. (A) Eye position and eye movements had completely recovered. (B) Hess chart shows recovery of the eye position and movement.