Abstract
We present a case of direct pituitary gland injury accompanied by progressive carotid injury in transorbital penetrating trauma. A 53-year- old woman sustained a penetrating injury to her left eye because of a twig and was transferred to our hospital. There was visual loss in the left eye and mild disturbance of consciousness. Initial computed tomography revealed that the foreign body was embedded in the left orbit and penetrated till the left anterior clinoid process. Carotid angiography (CAG) revealed luminal irregularity of the left internal carotid artery (ICA) in the cavernous portion. The foreign body was surgically removed, and transient diabetes insipidus developed during the operation. Magnetic resonance imaging revealed a low-signal-intensity lesion in the left side of the pituitary gland. Left CAG on day 7 revealed aneurysm formation at the site of the luminal irregularity, which was inferred to be an impending rupture. Left ICA, including the aneurysm, was successfully treated by coil embolization on day 24. The patient was discharged on day 35, with complete blindness of the left eye, but no other problems. Complications of penetrating head trauma are sometimes unexpected, and careful and repeated examinations are strongly recommended for proper evaluation and treatment.
