Integrated management of concurrent traumatic penetrating brain injury and electrical injury: illustrative case.

Background: Transorbital penetrating brain injury (PBI) accompanied by electrical injury is an extremely rare presentation. This type of traumatic injury has a unique set of diagnostic and therapeutic challenges due to the potential multiple organ system involvement and severe neurological complications.

Observations: A 50-year-old male experienced a high-impact injury from a welding spike that penetrated the orbit just above the eyeball with a concurrent electrical injury; the electricity exited through the great toe. Initial assessments revealed extensive subarachnoid pneumocephalus and a linear hemorrhage extending from the left medial orbital wall through the ethmoid air cells to the right thalamic nucleus. Remarkably, the eye itself was not injured given the superior trajectory of the spike within the orbit.

Lessons: PBIs and electrical injuries usually cause serious sequelae, but the welding spike and electrical current managed to avoid major neuroanatomical structures and visceral organs, allowing the patient to recover with minimal deficits. https://thejns.org/doi/10.3171/CASE24418.