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Peculiar case of acute periorbital oedema in patient with past traumatic brain injury and orbit bone defect. Understanding the importance of taking a thorough medical history

Poster Details


First Author: A.Papazacharia GREECE

Co Author(s): E. Kanonidou                    

Abstract Details

Purpose:

Patients with periorbital oedema present to emergency departments occasionally. Orbital cellulitis is a common cause but other causes should always be taken into consideration. Although potentially life and sight threatening causes are rare, an accurate diagnosis is of great importance and a thorough medical history can provide useful information regarding the diagnosis.

Setting:

Department of Ophthalmology, Hippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

36-year-old male presented to the ophthalmology outpatient clinic with swollen upper and lower eyelids and pain in his right eye. Past medical history was unremarkable. Ocular examination disclosed: VA: 10/10 bilaterally, ocular motility normal, no diplopia present, normal fundoscopy, swollen and erythematous left upper and lower eyelid. During the initial examination he was apyrexic. A diagnosis of orbital cellulitis was made and the patient was hospitalised and placed under systemic treatment with cefuroxime 750mg TID. Given the atypical nature of the presentation, a brain CT was arranged.

Results:

Blood tests revealed increased CRP: 118 mg/L. Suprisingly, both CT brain and MRI brain showed an encephalocele in the ethmoidal right sinus as well as a brain defect of the right orbit. When asked in second time, the patient admitted having a traumatic brain injury when he was a kid. The patient was then referred to the combined care of neurosurgeons and ENT surgeons, while there was a significant improvement of the oedema as well as a drop of CRP from 118 down to 6 mg/L.

Conclusions:

History taking is a very important step in differentiating diagnoses that can mimic orbital cellulitis. A doctor must always keep in mind that a patient could be deliberately hiding information, or because he doesn’t consider this information as crucial, and thus be misdiagnosed. The differential diagnosis of orbital cellulitis contains a large variant of diseases and every small detail of the medical history can provide the doctor with important information over the diagnosis.

Financial Disclosure:

None

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