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).
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.
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