Imaging findings in transorbital intracranial penetrating injury with an ice pick

Imaging evaluation is a must before surgery because most of the patients present with a minor external injury and intact neurological status.1 CT helps to assess the location, extent of the penetrating injury and damage caused by the object; detects retained hyperdense foreign bodies, cranial fractures and location of displaced fracture fragments; and helps in surgical planning. Turbin et al divided the orbital surface into four zones, which can predict the course of the penetrating object and resultant damage to the ocular or intracranial structures using 3D CT reconstructions.2 Transorbital intracranial injuries can be classified depending on the presence or absence of orbital fractures; involvement of orbital foramen or fissures; presence of injury to the globe, nerves, vessels or cerebrum; and whether there are associated calvarial or facial fractures. 3D CT reconstruction of angiography studies enables an excellent depiction of the course of the penetrating objects in relation to important intracranial structures and blood vessels.3 However, CT may sometimes underestimate the depth of injury.1 MRI is indicated to assess the status of the optic nerve, know the exact site of the transection and detect intracranial complications. Learning points Transorbital intracranial penetrating injuries may present with small external injuries and indolent clinical presentation; however, these cases must be dealt with utmost caution, and cross-sectional imaging evaluation must be performed to determine the extent of injury and detect retained foreign bodies and for surgical planning.