Transorbital Intracranial Stab Wounds

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FOUR cases of transorbital intracranial stab wounds are presented, each one illustrating a different clinical picture and demonstrating the vulnerability of the brain when approached through the thin-walled, funnel-shaped orbit.

Although much has been written concerning the incidence of wounds of the cranial contents as well as numerous articles pertaining to wounds of the orbital contents, relatively little has appeared about wounds which involve the intracranial structures by way of the orbits. This is difficult to understand since this is one of the most accessible modes of entry to the brain for stabbing instruments. Possibly it is due to the fact that most such serious wounds are rapidly fatal while some of the milder cases are undiagnosed because they exhibit few intracranial symptoms. These 4 cases serve to illustrate several of the possibilities which may be encountered in such wounds.

A group of war wounds involving the orbit and adjacent brain structures is discussed by Webster, Schneider and Lofstron.1 These were often injuries caused by high explosives and significant in the damage produced. The mortality in their series was 12.5 per cent as compared with a mortality rate of 6.4 per cent in penetrating wounds of the cranium generally. According to Courville and Schillinger,2 Kuntzman reports the case of a patient who stuck a pencil through the roof of the orbit into the brain, developed meningitis and died. Evatt3 reports a case of an ice pick stab in the orbit which was first seen three hours after admission and which. . .



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