I am currently in clinicals and had a pt recently with pontine bleed. Pt had severe periorbital edema in only one eye, looked almost like a hematoma or infection. A nurse said this was common in such head injuries, and I am curious as to why. Is this seen often, or is it simply caused by cerebral edema from previous injury? No history of fall or contusion leading up to event. Thanks for any input! :-)
Oct 23, '12
I saw this post and thought I could respond. Periorbital edema is obviously caused by trauma (MVC, Fall, and surgical). But if a pt has severe cerebral edema, you could argue that all the surrounding tissue including the face is subject to capillary leak. And even though a fall isn't recorded or witnessed at home, it is more likely they did fall. Some people become confused and fall, then get back up, fall again, and then sit somewhere and that's when family gets to them. Or, family notices the pt never picked up the phone, so they drive over and never assume a fall occurred b/c they didn't witness it, even though it's been happening all day long. This sounds more like the case, especially since your pt had unilateral swelling with an orbital hematoma.
Oct 23, '12
I had severe cerebral edema related to a brain tumor. Tumor was positioned in my frontal lobe behind my right eye. Prior to my diagnosis (and continuing until tumor was removed) I had swelling all around my right eye, at times it even felt like my eye was pushing out of the socket. After my surgery, even though the surgeon didn't touch my eye, I had severe swelling and bruising around my eye, spreading over to the other eye eventually, though my right eye was swollen shut for a few days.
Oct 24, '12
Thanks all for the responses, I genuinely appreciate it! I could rationalize that you can never be certain a fall didn't happen. Very interesting in the way it presented, makes sense the fluid would shift to the least restrictive area in the case of severe cerebral edema. :-)