• Xavier A Santander, Juan Manuel Revuelta, Carlos Cotúa, Arellano Rodriguez Beatriz B Department of Otorhinolaryngology, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain., Patricia de Leyva Moreno, and Saab Mazzei Anwar A Department of Neurosurgery, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain. Electronic address: anwarsm@gmail.com..
• Department of Neurosurgery, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain.
• World Neurosurg. 2019 Jun 1; 126: 530-532.

BackgroundWe present the case of a 51-year-old male with an occult transorbital intracranial injury after a car accident. The identified foreign object was a windshield wiper handle. To our knowledge, this is the first case reported.Case DescriptionMultidisciplinary treatment with maxillofacial and otorhinolaryngology departments was planned. A bifrontal craniotomy with removal of the foreign object and posterior orbital reconstruction were performed. A review of the literature was done, in order to highlight certain general principles in decision making despite the variability in case presentation.ConclusionsOccult TII is a rare subtype of penetrating brain injury. Diagnosis requires high suspicion as it can be missed during physical examination. Computed tomography (CT) scan, CT angiogram, and magnetic resonance imaging should be performed in order to design the optimal treatment for each patient. Magnetic resonance imaging should be avoided when metallic density on CT is observed. The use of a broad-spectrum antibiotic regimen is critical.Copyright © 2019 Elsevier Inc. All rights reserved.

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