Raccoon eyes

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Raccoon eyes
Other namesPanda eyes, periorbital ecchymosis
Racoon eyes injury with csf leak csv hariadhi.svg
Bilateral raccoon eyes with CSF leak
Specialty Neurosurgery
Causes Le Fort 2 and 3 fracture
Bilateral raccoon eyes Bilateral periorbital ecchymosis (raccoon eyes).jpg
Bilateral raccoon eyes

Raccoon eyes, also known as panda eyes or periorbital ecchymosis, is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. [1] [2] Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses. In lay terms, blood from skull fracture seeps into the soft tissue around the eyes. Raccoon eyes may be accompanied by Battle's sign, an ecchymosis behind the ear. These signs may be the only sign of a skull fracture, as it may not show on an X-ray. They normally appear between 48 and 72 hours (2-3 days) after the injury. [3] It is recommended that the patient not blow their nose, cough vigorously, or strain, to prevent further tearing of the meninges. [4]

Raccoon eyes may be bilateral or unilateral. [5] If unilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. They are most often associated with fractures of the anterior cranial fossa. [6] [7]

Raccoon eyes may also be a sign of disseminated neuroblastoma, amyloidosis, Kaposi’s sarcoma or multiple myeloma. [8] It also can be temporary result of rhinoplasty. [9]

Depending on cause, raccoon eyes always require urgent consultation and management, whether surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).

See also

Related Research Articles

<span class="mw-page-title-main">Cranial nerves</span> Nerves that emerge directly from the brain and the brainstem

Cranial nerves are the nerves that emerge directly from the brain, of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and from regions of the head and neck, including the special senses of vision, taste, smell, and hearing.

<span class="mw-page-title-main">Headache</span> Pain in the head, neck, or face

Headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.

<span class="mw-page-title-main">Abducens nerve</span> Cranial nerve VI, for eye movements

The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve.

<span class="mw-page-title-main">Bruise</span> Type of localized bleeding in tissues outside blood vessels

A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.

<span class="mw-page-title-main">Epidural hematoma</span> Build-up of blood between the dura mater and skull

Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. When this condition occurs in the spinal canal, it is known as a spinal epidural hematoma.

<span class="mw-page-title-main">Battle's sign</span> Bruises behind the ears, indicating skull fracture

Battle's sign, also known as mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull. These fractures may be associated with underlying brain trauma. Battle's sign consists of bruising over the mastoid process as a result of extravasation of blood along the path of the posterior auricular artery. The sign is named after William Henry Battle.

<span class="mw-page-title-main">Facial nerve paralysis</span> Loss of motor function in the facial muscles

Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. The pathway of the facial nerve is long and relatively convoluted, so there are a number of causes that may result in facial nerve paralysis. The most common is Bell's palsy, a disease of unknown cause that may only be diagnosed by exclusion of identifiable serious causes.

<span class="mw-page-title-main">Crown (anatomy)</span> Top of the head

The crown is the top portion of the head behind the vertex. The anatomy of the crown varies between different organisms. The human crown is made of three layers of the scalp above the skull. The crown also covers a range of bone sutures, and contains blood vessels and branches of the trigeminal nerve.

<span class="mw-page-title-main">Skull fracture</span> Medical condition

A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull, usually occurring as a result of blunt force trauma. If the force of the impact is excessive, the bone may fracture at or near the site of the impact and cause damage to the underlying structures within the skull such as the membranes, blood vessels, and brain.

<span class="mw-page-title-main">Basilar skull fracture</span> Bone breakage in the base of the skull

A basilar skull fracture is a break of a bone in the base of the skull. Symptoms may include bruising behind the ears, bruising around the eyes, or blood behind the ear drum. A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and may result in fluid leaking from the nose or ear. Meningitis occurs in about 14% of cases. Other complications include injuries to the cranial nerves or blood vessels.

<span class="mw-page-title-main">Cranial cavity</span> Space inside the skull formed by eight cranial bones known as the neurocranium

The cranial cavity, also known as intracranial space, is the space within the skull that accommodates the brain. The skull minus the mandible is called the cranium. The cavity is formed by eight cranial bones known as the neurocranium that in humans includes the skull cap and forms the protective case around the brain. The remainder of the skull is called the facial skeleton. Meninges are protective membranes that surround the brain to minimize damage to the brain in the case of head trauma. Meningitis is the inflammation of meninges caused by bacterial or viral infections.

<span class="mw-page-title-main">Sixth nerve palsy</span> Medical condition

Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI, which is responsible for causing contraction of the lateral rectus muscle to abduct the eye. The inability of an eye to turn outward, results in a convergent strabismus or esotropia of which the primary symptom is diplopia in which the two images appear side-by-side. Thus, the diplopia is horizontal and worse in the distance. Diplopia is also increased on looking to the affected side and is partly caused by overaction of the medial rectus on the unaffected side as it tries to provide the extra innervation to the affected lateral rectus. These two muscles are synergists or "yoke muscles" as both attempt to move the eye over to the left or right. The condition is commonly unilateral but can also occur bilaterally.

<span class="mw-page-title-main">Subgaleal hemorrhage</span> Bleeding between the skull and fibrous tissue enclosing it

Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.

<span class="mw-page-title-main">Cavernous sinus thrombosis</span> Medical condition

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. This is a rare disorder and can be of two types–septic cavernous thrombosis and aseptic cavernous thrombosis. The most common form is septic cavernous sinus thrombosis. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the associated bacteria.

<span class="mw-page-title-main">Orbital blowout fracture</span> Medical condition

An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall that typically results from the impact of a blunt object larger than the orbital aperture, or eye socket. Most commonly this results in a herniation of orbital contents through the orbital fractures. The proximity of maxillary and ethmoidal sinus increases the susceptibility of the floor and medial wall for the orbital blowout fracture in these anatomical sites. Most commonly, the inferior orbital wall, or the floor, is likely to collapse, because the bones of the roof and lateral walls are robust. Although the bone forming the medial wall is the thinnest, it is buttressed by the bone separating the ethmoidal air cells. The comparatively thin bone of the floor of the orbit and roof of the maxillary sinus has no support and so the inferior wall collapses mostly. Therefore, medial wall blowout fractures are the second-most common, and superior wall, or roof and lateral wall, blowout fractures are uncommon and rare, respectively. They are characterized by double vision, sunken ocular globes, and loss of sensation of the cheek and upper gums from infraorbital nerve injury.

<span class="mw-page-title-main">Periorbital puffiness</span> Appearance of swelling around the eyes

Periorbital puffiness, also known as puffy eyes, or swelling around the eyes, is the appearance of swelling in the tissues around the eyes, called the orbits. It is almost exclusively caused by fluid buildup around the eyes, or periorbital edema. Minor puffiness usually detectable below the eyes only is often called eye bags. Such transient puffiness is distinct from the age related and gradual increase in the size of the fat pad lying below the lower eyelids which can also be colloquially referred to as eye bags.

Cerebrospinal fluid rhinorrhoea refers to the drainage of cerebrospinal fluid through the nose (rhinorrhoea). It is typically caused by a basilar skull fracture, which presents complications such as infection. It may be diagnosed using brain scans, and by testing to see if discharge from the nose is cerebrospinal fluid. Treatment may be conservative, but usually involves neurosurgery.

<span class="mw-page-title-main">Dislocation of jaw</span> Medical condition

Dislocations occur when two bones that originally met at the joint detach. Dislocations should not be confused with subluxation. Subluxation is when the joint is still partially attached to the bone.

<span class="mw-page-title-main">Familial Amyloidosis, Finnish Type</span> Medical condition

Familial Amyloidosis, Finnish Type (FAF), also called hereditary gelsolin amyloidosis and AGel amyloidosis (AGel), is an amyloid condition with a number of associated cutaneous and neurological presentations deriving from the aberrant proteolysis of a mutated form of plasma gelsolin. First described in 1969 by the Finnish ophthalmologist Jouko Meretoja, FAF is uncommon with 400–600 cases described in Finland and 15 elsewhere.

<span class="mw-page-title-main">Orbital emphysema</span> Medical condition

Orbital emphysema is a medical condition that refers to the trapping of air within the loose subcutaneous around the orbit that is generally characterized by sudden onset swelling and bruising at the impacted eye, with or without deterioration of vision, which the severity depends on the density of air trapped under the orbital soft tissue spaces.

References

  1. Herbella, FA; Mudo M; Delmonti C; Braga FM; Del Grande JC (December 2001). "'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture". Injury. 32 (10): 745–47. doi:10.1016/S0020-1383(01)00144-9. PMID   11754879.
  2. EMT Prehospital Care (4th Edition)
  3. Handbook of Signs & Symptoms (Third Edition)
  4. Nursing: Interpreting Signs and Symptoms
  5. "Skull fractures. Step-by-step diagnostic approach". Best Practice, BMJ.
  6. "BMJ Best Practice". bestpractice.bmj.com.
  7. Visual Diagnosis in Emergency and Critical Care Medicine, Christopher P. Holstege, Alexander B. Baer, Jesse M. Pines, William J. Brady, p. 228
  8. Gumus K (2007). "A child with raccoon eyes masquerading as trauma". Int Ophthalmol . 27 (6): 379–81. doi:10.1007/s10792-007-9089-y. PMID   17534581. S2CID   5921.
  9. Steinbacher, Derek M. (2019-05-21). Aesthetic Orthognathic Surgery and Rhinoplasty. John Wiley & Sons. ISBN   978-1-119-18697-7.