title: Pseudo-Orbital Apex Syndrome in the Acute Trauma Setting Due to Ipsilateral Dissection of Internal Carotid Artery.
abstract: Traumatic causes of orbital apex and superior orbital fissure syndrome are uncommon. The authors present the first case of a traumatic superior orbital fissure syndrome simulating orbital apex syndrome, with loss of vision from posterior ischemic optic neuropathy. A 35-year-old man was initially felt to have a right orbital apex syndrome with left craniofacial and orbital trauma. CT revealed left orbital fractures, a right superior orbital fissure fracture, a retained metallic foreign body in the right sphenoid sinus, and a right frontoparietal subdural hematoma. CT angiography showed a secondary dissection and occlusion of the right internal carotid artery from osseous erosion of the posterolateral wall of the sphenoid sinus. Internal carotid artery dissection is a possible, though rare, cause of ischemic optic neuropathy. The right pseudo-orbital apex syndrome resulted from a mechanical superior orbital fissure syndrome and posterior ischemic optic neuropathy from an internal carotid artery dissection.
authors.affiliation: *Martel Eye Medical Group, Rancho Cordova; †California Northstate University College of Medicine, Elk Grove; and ‡Dignity Health, Carmichael, California, U.S.A.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Anders
authors.forename: Elise J
authors.initials: EJ
authors.lastname: Taylor
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Martel
authors.forename: James B
authors.initials: JB
authors.lastname: Martel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis; D002343:Carotid Artery, Internal; D005131:Eye Injuries / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D009916:Orbital Diseases / Q000175:diagnosis / Q000209:etiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis