Acta Neurochirurgica

, Volume 160, Issue 5, pp 913–917 | Cite as

Traumatic subarachnoid hemorrhage related to ophthalmic artery avulsion: a case report

  • Alessandro Prior
  • Luca Allegretti
  • Ilaria Melloni
  • Marta Bovio
  • Francesco Laganà
  • Marco Ceraudo
  • Gianluigi Zona
Case Report - Brain Injury


We present a case of ophthalmic artery (OA) traumatic avulsion, leading to a post-traumatic subarachnoid hemorrhage (SAH) with ventricular blood invasion and hydrocephalus, mimicking an internal carotid aneurysm rupture. This is the third case of such an event reported in literature and the first without orbital fractures and optic nerve avulsion. Conservative treatment was sufficient for the avulsion, but surgery was needed for the coexisting eye luxation. Traumatic OA avulsion is a rare but possible event and should be suspected in case of basal cisterns SAH, evidence of orbital trauma and CT angiogram or angiographic absence of opacification of the OA.


Ophthalmic artery avulsion Traumatic SAH Brain trauma Ophthalmic artery Orbital trauma 



Chronic obstructive pulmonary disease


Computed tomography


External Ventricular Drainage


Emergency Department


Intracranial pressure


Intensive care unit


Ophthalmic artery


Subarachnoid hemorrhage


Traumatic Brain Injury


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The next of kin has consented to submission of this case report to the journal.


  1. 1.
    Bajaj MS, Pushker N, Nainiwal SK, Balasubramanya R (2003) Traumatic luxation of the globe with optic nerve avulsion. Clin Exp Ophthalmol 31(4):362–363CrossRefPubMedGoogle Scholar
  2. 2.
    Ballard SR, Enzenauer RW, O’Donnell T, Fleming JC, Risk G, Waite AN (2009) Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital haemorrhage. J Spec Oper Med 9(3):26–32PubMedGoogle Scholar
  3. 3.
    Christie B, Block L, Ma Y, Wick A, Afifi A (2017) Retrobulbar hematoma: a systematic review of factors related to outcomes. J Plast Reconstr Aesthet Surg.
  4. 4.
    Dasenbrock HH, Yan SC, Gross BA, Guttieres D, Gormley WB, Freichs KU, Ali Aziz-Sultan M, Du R (2017) The impact of aspirin and anticoagulant usage on outcomes after aneurysmal subarachnoid hemorrhage: a nationwide inpatient sample analysis. J Neurosurg 126(2):537–547CrossRefPubMedGoogle Scholar
  5. 5.
    Eisenberg HM, Gary HE Jr, Aldrich EF, Saydjari C, Turner B, Foulkes MA, Jane JA, Marmarou A, Marshall LF, Young HF (1990) Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73(5):688–698CrossRefPubMedGoogle Scholar
  6. 6.
    Gross BA, Rosalind Lai PM, Frerichs KU, Du R (2014) Aspirin and aneurysmal subarachnoid hemorrhage. World Neurosurg 82:1127–1130CrossRefPubMedGoogle Scholar
  7. 7.
    Kumari E, Chakraborty S, Ray B (2015) Traumatic globe luxation: a case report. Indian J Ophthalmol 63(8):682–684CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Limbrick DD Jr, Behdad A, Derdeyn CP, Custer PL, Zipfel GJ, Santiago P (2009) Traumatic enucleation with avulsion of the ophthalmic artery resulting in aneurysm-like subarachnoid hemorrhage. J Neurosurg 111(4):653–657CrossRefPubMedGoogle Scholar
  9. 9.
    Mattioli C, Beretta L, Gerevini S, Veglia F, Citerio G, Cormio M, Stocchetti N (2003) Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg 98(1):37–42CrossRefPubMedGoogle Scholar
  10. 10.
    McClenaghan FC, Ezra DG, Holmes SB (2011) Mechanisms and management of vision loss following orbital and facial trauma. Curr Opin Ophthalmol 22:426–431CrossRefPubMedGoogle Scholar
  11. 11.
    Morris GF, Bullock R, Marshall SB, Marmaru A, Maas A, Marshall LF (1999) Failure of the competitive N-methyl-D-aspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two phase III clinical trials. The Selfotel Investigators. J Neurosurg 91(5):737–743CrossRefPubMedGoogle Scholar
  12. 12.
    Nabavizadeh SA, Assadsangabi R, Pukenas B, Mamourian A (2015) Subarachnoid hemorrhage secondary to ophthalmic artery avulsion. J Neurol Sci 358(1–2):477–478CrossRefPubMedGoogle Scholar
  13. 13.
    Orlandi D, Sconfienza LM, Lacelli F, Bertolotto M, Sola S, Mauri G, Savarino E, Serafini G (2013) Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions. Eur Radiol 23(7):1919–1924CrossRefPubMedGoogle Scholar
  14. 14.
    Osman EA, Al-Akeely A (2014) Luxation of eye ball following trauma: novel simple treatment. Indian J Ophthalmol 62:812–813CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Suzuki N, Fujitsu K, Tanaka N, Sekino T, Kuwabara T, Yuda K (1988) Traumatic enucleation of the eye ball–report of a case and considerations concerning the pathogenic mechanism of intracranial complications. No Shinkei Geka 16:1293–1297PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinica Neurochirurgica e Neurotraumatologica, IRCCS Policlinico San MartinoGenoaItaly
  2. 2.U.O. Neuroradiologia, IRCCS Policlinico San MartinoGenoaItaly
  3. 3.U.O. Medicina e Chirurgia d’Accettazione e Urgenza, IRCCS Policlinico San MartinoGenoaItaly
  4. 4.U.O. Chirurgia Maxillo-faciale, IRCCS Policlinico San MartinoGenoaItaly

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