ResidentTraumaFINALhighres

Figure 3.17

Dislocated lens seen displaced to inferior portion of anterior chamber of the globe.

but possible (Figure 3.17). Rupture of the globe is also a rare, but

devastating, injury.

f. Imbalance

Imbalance may be present in patients with NOE injuries, primarily in

patients with serious trauma to the face that can cause a concussion,

anterior skull base contusion, cerebral edema, or injury to the medial

longitudinal fasciculus. Contrecoup injuries to the brainstem and

vestibular/cerebellar pathways may have occurred; these signs are

ominous for more serious intracranial pathology. Nystagmus may be a

feature of contrecoup trauma.

g. Anosmia

Anosmia is another worrisome sign. If the patient fails to perceive the

smell of common scents, such as soap or alcohol, further investigation

is warranted. The cause may simply be an accumulation of blood,

mucus, and swollen nasal membranes, but could also be due to a

disruption of the olfactory nerve at the level of the cribriform plate. If

this injury is suspected, the patient should be tested for CSF rhinorrhea,

using filter paper in the front-leaning-head position or collected and

tested for beta-2 transferrin.