Transorbital penetrating head trauma caused by a chopstick: importance of early vascular assessment and infection prophylaxis – a case report

Background Penetrating cranial injuries are rare, accounting for < 1% of all head trauma. In Western countries most result from firearms, whereas in Japan they usually occur from accidental impalement with objects such as chopsticks or pencils. Because the orbit contains vital neurovascular structures, even minor penetration can cause intracranial vascular injury or infection. Rapid identification of the route, vascular evaluation, and infection control are crucial. We report a rare case of transorbital penetrating head trauma caused by a chopstick. Case presentation An Asian woman in her fifties was found unconscious after accidentally impaling the inside of her right eye with a chopstick while serving food in the dark for her family. A chopstick had penetrated vertically into the medial aspect of the right orbit to a depth of approximately 13 cm. Head CT revealed that the chopstick had penetrated through the medial orbital wall and crossed the right side of the midbrain and pons, with the tip reaching the occipital lobe just above the tentorium cerebelli. CT angiography showed the foreign body near the cavernous segment of the right internal carotid and posterior cerebral arteries. After preparation for possible endovascular intervention, the chopstick was carefully extracted under angiographic guidance. Follow-up angiography on day 8 showed mild irregularity of the internal carotid artery and focal narrowing of the posterior cerebral artery. As both were asymptomatic with preserved distal perfusion, conservative management was chosen. Serial brain MR angiography demonstrated gradual improvement in these vascular abnormalities. She was transferred to a rehabilitation facility for cognitive rehabilitation due to higher brain dysfunction on day 65. Conclusions Transorbital penetrating injuries are uncommon in Japan but carry highly mortality (25–28%). Prognostic factors that significantly influence survival include direct parenchymal brain injury, intracranial vascular injury, and intracranial infection. In this case, CT and angiography delineated the tract and vascular involvement, allowing safe removal of the foreign body. Serial imaging and vigilance for delayed vascular complications such as pseudoaneurysm or vasospasm are essential. Early vascular assessment and antibiotic prophylaxis remain key to favorable outcomes.