Traumatic Bilateral Self-Enucleation With Subarachnoid Hemorrhage

Abstract

We present a rare case of traumatic self-enucleation of the bilateral globes resulting in traumatic subarachnoid and intraventricular hemorrhages. This case highlights the critical importance of multidisciplinary trauma care, starting with recognition of the potential for less obvious injuries such as contralateral optic nerve injury in unilateral enucleation, intracranial hemorrhage, and cerebrovascular injuries. We highlight the role of a thorough trauma assessment and workup, especially in the context of highly distracting injuries in patients who may also have severe mental illness. The trauma and acute care surgeon, who also serves as the critical care specialist, should be well prepared to facilitate care between multiple subspecialists including neurosurgeons, interventional radiologists, vascular surgeons, and psychiatrists, with a high index of suspicion for occult trauma in seemingly isolated injuries.

Keywords: critical care; enucleation; ophthalmic artery; subarachnoid hemorrhage; trauma.

Figure 1.

Appearance of the patient upon presentation. Significant bleeding has occurred, and blood obscures detailed examination of the posterior orbits at this time.

Figure 2.

Suprasellar subarachnoid hemorrhage is demonstrated anteriorly with posterior extension into the inferior aspect of the third ventricle.