[Traumatic enucleation of the eye ball--report of a case and considerations concerning the pathogenic mechanism of intracranial complications].

: A 48-year-old man had his left eye ball enucleated by fingers of an assailant. The optic nerve, measuring 4 cm in length, was attached to the enucleated eye ball, but there was neither a wound in his eyelids nor cerebrospinal fluid leakage from inside the orbit. He was confused, but responsive and was able to recognize other persons with his right eye. His right-eye vision deteriorated within 24 hours and was almost totally lost for about one month. Three months after the trauma his vision recovered to 0.1, but his visual field showed severe concentric narrowing. An emergency CT on admission showed a small subarachnoid hemorrhage in the suprasellar cistern, and follow-up CT scanning on day 7 demonstrated a small infarction in the left globus pallidus and putamen. Cerebral angiography performed on day 17 showed residual vasospasm of the horizontal portion of left anterior cerebral artery. Left ophthalmic artery was patent and there was no aneurysm formation either on the intracranial or on the intraorbital arteries. Literature review yielded only three cases of eye ball enucleation by an assailant. Intracranial complications reported in the literature, including those associated with eye ball enucleation caused by other mechanisms, are; contralateral visual field defect: seven cases, hypothalamic involvement: two cases, subarachnoid hemorrhage: two cases, cerebrospinal fluid leakage: one case, and meningitis: one case. The optic nerve, from just behind the eye ball to the chiasm, is reported to be 40-50 mm long, and eye ball enucleation with the optic nerve measuring 4 cm or more is quite likely to cause intracranial complications such as are cited above.