Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Feb 15;46(4):270-274.
doi: 10.1080/01658107.2022.2034891. eCollection 2022.

Acute Enophthalmos After Lumbar Puncture in a Patient with Type 1 Neurofibromatosis Related Sphenoid Wing Dysplasia

Deanna Ingrassia Miano  1 , Gregory Byrd  2 , Rani Kattoula  2 , Aye Thet  2 , Ryan Adkins  3 , Ryan Cosgrove  1 , Samantha S Johnson  1
Affiliations
Case Reports

Acute Enophthalmos After Lumbar Puncture in a Patient with Type 1 Neurofibromatosis Related Sphenoid Wing Dysplasia

Deanna Ingrassia Miano et al. Neuroophthalmology. .

Abstract

A 19-year-old woman with type 1 neurofibromatosis related sphenoid wing dysplasia underwent a lumbar puncture (LP) after an unexplained syncopal event. The cerebrospinal fluid work-up was unremarkable. However, 30-hours post LP, she developed marked enophthalmos ipsilateral to the calvarial dysplasia. The enophthalmos gradually resolved within 72 hours. We surmise that the patient's enophthalmos was due to an LP induced decrease of intracranial pressure in conjunction with the orbital bone anomaly.

Keywords: Enophthalmos; intracranial hypotension; neurofibromatosis type 1; sphenoid wing dysplasia.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
(A) Two serial image slices from computed tomography (CT) scan without contrast taken prior to the lumbar puncture (LP). Right sphenoid wing dysplasia is appreciated. An axis has been drawn between bilateral zygomatic bones demonstrating the globe position prior to intervention. (B) Two serial image slices from the CT without contrast taken after the LP. When assessing the globe relative to the inter-zygomatic axis, a posterior displacement of the right globe is appreciated when compared with the left globe. Similarly, the right eye has migrated posteriorly as compared to its pre-LP state in Figure 1A. Images in Figures 1A,B slightly vary based on the patient’s head tilt during scanning.
Figure 2.
Figure 2.
External photograph taken after the lumbar puncture demonstrating notable enophthalmos of the right eye compared with the left eye.
Figure 3.
Figure 3.
T1-weighted magnetic resonance imaging withcontrast taken after treatment with intravenous fluids, steroids and antibiotics demonstrating mild anterior displacement of the right eye orbital contents as noted from the inter-zygomatic axis. Right-sided dacryoadenitis can also be appreciated.
See this image and copyright information in PMC

References

    1. Tam A, Sliepka JM, Bellur S, Bray CD, Lincoln CM, Nagamani SC.. Neuroimaging findings of extensive sphenoethmoidal dysplasia in NF1. Clin Imaging. 2018. Sep 1;51:160–163. doi:10.1016/j.clinimag.2018.04.017. - DOI - PMC - PubMed
    1. Arrington DK, Danehy AR, Peleggi A, Proctor MR, Irons MB, Ullrich NJ.. Calvarial defects and skeletal dysplasia in patients with neurofibromatosis type 1. J Neurosurg. 2013. Apr 1;11(4):410–416. doi:10.3171/2013.1.PEDS12409. - DOI - PubMed
    1. Cassiman C, Legius E, Spileers W, Casteels I. Ophthalmological assessment of children with neurofibromatosis type 1. Eur J Pediatr. 2013. Oct 1;172(10):1327–1333. doi:10.1007/s00431-013-2035-2. - DOI - PubMed
    1. Ye YF, Zhang HC, Xie YN, Sun JJ, Wang YN. A case of neurofibromatosis type I presenting with rapid enophthalmos caused by thoracocentesis. Clin Exp Ophthalmol. 2009. Sep;37(7):752–754. - PubMed
    1. Hamedani M, Pournaras JA, Goldblum D. Diagnosis and management of enophthalmos. Surv Ophthalmol. 2007. Sep 1;52(5):457–473. doi:10.1016/j.survophthal.2007.06.009. - DOI - PubMed

Publication types