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Frontal contusion epidural hematoma that mimics a tensioned retrobulbar hemorrhage in clinical presentation.

A 13-year-old male boy was brought to the emergency room 24 hours after he had crashed his bicycle into a utility pole. Initially, he was transferred to a local hospital for first aid; however, the patient developed progressive right eye proptosis and blurred vision. He was alert, grossly without neurologic deficits. Physical examination revealed right ophthalmoplegia, decreased visual ability, and poor reflex to light. Under the suspicion of retrobulbar hemorrhage, an emergent craniofacial computed tomography disclosed right frontal intracerebral hemorrhage (Fig. 1, A) and a well-defined hematoma in the right orbital cavity (Fig. 1, B). Blood was most possibly accumulated beneath the pericranium at the frontal area. The mass effect was not large enough to induce cerebral symptoms, but already the extraocular muscles had compressed the optic nerve. The ophthalmic symptoms slowly progressed and warranted immediate decompression procedure. The approach was later referred to a plastic surgeon by the neurosurgeon. A 1.5-cm incision was made along the right lateral upper eyelid crease. After entering the orbicularis oculi muscle, the dissection plane was turned upward until touching the frontal bone. A blunt tip scissor was used for minimal spreading of the frontalis muscle, and the hematoma space was entered after opening the tense periosteum of frontal bone with a sharp elevator. The high-pressure blood clot was released by negative pressure suction. The wound was closed with the skin layer without any drainage. The patient recovered uneventfully and was discharged from hospital on day 5. A follow-up visual ability and eye movement 2 weeks later revealed complete recovery.