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Neurology Resident and Fellow Section

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1 Neurology Resident and Fellow Section
A 65 year old with facial trauma Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

2 Vignette A 65 year-old woman presented with head/facial trauma secondary to seizure Examination revealed right-sided facial contusions and subconjunctival hemorrhage Over 24 hours she developed bilateral periorbital ecchymoses There was no mastoid ecchymosis (Battle’s sign) Tarolli et al. © 2013 American Academy of Neurology

3 Imaging Tarolli et al. Figure Legend:
Figure 1: Bilateral periorbital ecchymoses (raccoon eyes) Tarolli et al. © 2013 American Academy of Neurology

4 Imaging Tarolli et al. Figure Legend:
Figure 2: Head CT: Comminuted fracture of the medial wall of the orbit with hemorrhage protruding into the orbit (A) bone window, (B) brain window Tarolli et al. © 2013 American Academy of Neurology

5 Unmasking Raccoon Eyes: A Classic Clinical Sign
Periorbital ecchymoses, “raccoon eyes” Neuroimaging revealed a right orbital fracture with hemorrhage protruding into the orbit without a skull base fracture Most commonly associated with basilar skull fracture Can be seen in unilateral and bilateral orbital fractures The differential, beyond trauma, most commonly includes metastatic neuroblastoma, Kaposi’s sarcoma, multiple myeloma, and amyloidosis References: 1: Herbella F, Mudo M, Delmonti C, Braga F, Del Grande JC. ‘Raccoon Eyes’ (periorbital haematoma) as a sign of skull base fracture. Injury 2001;32: 2: Gumus K. A child with raccoon eyes masquerading as trauma. International Ophthalmology 2007;27: Tarolli et al. © 2013 American Academy of Neurology

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