title: Non-traumatic Bilateral Orbital Subperiosteal Hematoma in a Person Who Attempted Suicide by Hanging.
abstract: Orbital subperiosteal hematomas are rare and most often result from facial trauma; however, occurrence of these hematomas due to non-traumatic causes is extremely rare. Herein, we present the case of a 38-year-old man who was transferred to our emergency department because he became comatose after attempting suicide by hanging. He underwent computed tomography (CT) of the head and neck. CT findings revealed a bilateral orbital subperiosteal hematoma. We then performed magnetic resonance imaging (MRI) of the head for definite diagnosis of hematoma. There is no consensus regarding if this condition should be treated conservatively or surgically. Conservative management was selected for this patient because he was in deep coma. Some non-traumatic causes of orbital subperiosteal hematoma include weight lifting, coughing, vomiting, Valsalva maneuver, labor, and scuba diving. Sudden elevations in cranial pressure may be the mechanism underlying this condition. Although suicide attempt by hanging could have caused a sudden elevation in cranial pressure, this is the first report of the occurrence of this condition. Patients with orbital subperiosteal hematomas generally complain of blurred vision, eye pain, or exophthalmos. However, identifying this sign may be difficult in patients with disturbed consciousness.
authors.affiliation: Department of Emergency and Critical Care Medicine, Odawara Municipal Hospital, 46 Kuno, Odawara, Kanagawa 250-8558, Japan. sakuraik@is.icc.u-tokai.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sakurai
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Mariko
authors.initials: M
authors.lastname: Sugita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Taira
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000150:complications*; D003128:Coma / Q000209:etiology; D006406:Hematoma / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019838:Neck Injuries / Q000150:complications*; D009916:Orbital Diseases / Q000175:diagnosis* / Q000209:etiology*; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed