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July 22, 2014; 83 (4) Resident and Fellow Section

Teaching NeuroImages: Unmasking raccoon eyes

A classic clinical sign

Christopher Tarolli, Michele A. Scully, Andrew D. Smith
First published July 21, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000611
Christopher Tarolli
From the University of Rochester Medical Center, NY.
MD
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Michele A. Scully
From the University of Rochester Medical Center, NY.
MD
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Andrew D. Smith III
From the University of Rochester Medical Center, NY.
MD
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Citation
Teaching NeuroImages: Unmasking raccoon eyes
A classic clinical sign
Christopher Tarolli, Michele A. Scully, Andrew D. Smith
Neurology Jul 2014, 83 (4) e58-e59; DOI: 10.1212/WNL.0000000000000611

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A 65-year-old woman presented with head/facial trauma secondary to seizure. Examination revealed right-sided facial contusions and subconjunctival hemorrhage. Over 24 hours she developed bilateral periorbital ecchymoses: “raccoon eyes” (figure 1). Neuroimaging revealed right orbital fracture with hemorrhage into the orbit (figure 2). There was no basilar skull fracture or Battle sign (mastoid ecchymosis).

Figure 1
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Figure 1 Bilateral periorbital ecchymoses (raccoon eyes)
Figure 2
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Figure 2 Head CT

Comminuted fracture of the medial wall of the orbit with hemorrhage protruding into the orbit: (A) bone window, (B) brain window.

Raccoon eyes, a clinical sign most commonly associated with basilar skull fracture, can be seen in unilateral and bilateral orbital fractures.1 The differential, beyond trauma, includes most commonly metastatic neuroblastoma, Kaposi sarcoma, multiple myeloma, and amyloidosis.2 Neurologists should be aware of this sign and its differential.

AUTHOR CONTRIBUTIONS

Christopher Tarolli: drafting/revising the manuscript, accepts responsibility for conduct of research and final approval. Michele A. Scully: drafting/revising the manuscript, accepts responsibility for conduct of research and final approval. Andrew D. Smith III: study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and final approval.

STUDY FUNDING

No targeted funding reported.

DISCLOSURE

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Download teaching slides: Neurology.org

  • © 2014 American Academy of Neurology

REFERENCES

  1. 1.↵
    1. Herbella F,
    2. Mudo M,
    3. Delmonti C,
    4. Braga F,
    5. Del Grande JC
    . “Raccoon eyes” (periorbital haematoma) as a sign of skull base fracture. Injury 2001;32:745–747.
    OpenUrlPubMed
  2. 2.↵
    1. Gumus K
    . A child with raccoon eyes masquerading as trauma. Int Ophthalmol 2007;27:379–381.
    OpenUrlPubMed
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