5/2/2023 0 Comments Panda eyes trauma![]() ![]() Hematological malignancies: blastic plasmacytoid dendritic cell neoplasm, lymphoblastic lymphoma, acute myeloid leukemia.Amyloidosis (most commonly, light chain (AL) type) – due to increased vascular fragility as a result of amyloid deposition – this is one of the most common causes of raccoon eyes other than trauma the finding presents in about one-fifth of patients with AL amyloidosis. ![]() Toxic products of neutrophils in the infiltrate may be responsible for vascular damage leading to erythrocyte extravasation.Raccoon sign in this condition is due to secondary vascular damage caused by prolonged exposure to matrix metalloproteinases. ![]() Sweet syndrome or acute febrile neutrophilic dermatosis is a skin disease characterized by the sudden onset of fever, an elevated white blood cell count, and tender, red, well-demarcated papules, and plaques that show dense infiltrates by neutrophil granulocytes on histologic examination.Lichen planus pigmentosus (hyperpigmentation due to pigment incontinence).Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome (neutrophilia and skin lesions containing mature neutrophils may also cause raccoon eyes appearance due to periorbital erythematous edema due to a predilection to involve periorbital skin).The neonatal lupus erythematosus (vasculitis may lead to facial and periorbital purplish-red plaques).Acute migraine (due to vasodilation and release of vasoactive substances including heparin).Sinus thrombosis – dural, superior sagittal sinus, and cavernous sinus thrombosis.Subarachnoid hemorrhage (SAH) from ophthalmic artery aneurysm.Posttraumatic orbital emphysema (due to fracture of orbital wall and entrapment of air from paranasal sinuses).Following vigorous sneezing, coughing or vomiting – probably due to periorbital venous hemorrhage.Minor periorbital trauma, like the plucking of eyebrows.Traumatic: unilateral and bilateral orbital fractures 8:.Basilar skull fractures are commonly associated with facial fractures, cervical spine injury, intracranial hemorrhage, cranial nerve injury, vascular injury, and meningitis 6.Īlthough commonly associated with skull base fracture, raccoon eye sign may also present in a variety of other conditions (limited to case reports), which include: Indirect radiographic findings that suggest basal skull fracture include pneumocephalus and air-fluid levels within, or opacification of, an air sinus. Tarsal plate sparing is due to an anatomic structure called the orbital septum, which limits extravasation of blood beyond the tarsal plate (Figure 2). Battle’s sign and unilateral blepharohematoma have the highest predictive value 5. ![]() Clinical signs are usually more sensitive 2. Signs of basal skull fracture may take several hours to develop and include cerebrospinal fluid (CSF) otorrhea or rhinorrhea, hemotympanum, laceration of the external auditory canal, Battle’s sign (postauricular or mastoid ecchymosis) and periorbital ecchymosis with tarsal plate sparing (Raccoon eyes). Basal skull fracture are often missed on CT and plain skull x-rays. Penetrating injuries such as gunshot wounds account for less than 10% of cases 4.īasal skull fracture most commonly involve the temporal bones but may involve the occipital, sphenoid, ethmoid and the orbital plate of the frontal bone as well. Falls and assaults are also important causes. Most basal skull fractures are caused by high-velocity blunt trauma such as motor vehicle collisions, motorcycle crashes, and pedestrian injuries. However, conditions potentially associated with basal skull fracture that may require specific management include traumatic aneurysms, posttraumatic carotid-cavernous fistula, cerebrospinal fluid fistula, meningitis, cerebral abscess, cosmetic deformities and posttraumatic facial palsy.īasal skull fractures, usually caused by substantial blunt force trauma, involve at least one of the bones that compose the base of the skull 3. The majority of basal skull fractures are managed with conservative care 2. Basal skull fractures are most commonly seen in younger people due to their propensity to do high-risk activities. The clinical triad comprising of unilateral or bilateral progressive proptosis, periorbital ecchymosis, and edema is called raccoon sign 1. Raccoon eyes may also be a sign of disseminated neuroblastoma. Raccoon eyes may also be referred to as panda eyes, especially in the UK. Raccoon eyes results from blood from skull fracture tracking down into the soft tissue around the eye. Raccoon eyes also known as bruising around the eyes or periorbital hematoma or periorbital bruising (ecchymosis) with tarsal plate sparing, is a sign of basal skull fracture. ![]()
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