Homonymous hemianopsia complicating treatment of postoperative epistaxis.

摘要

Following biopsy of a malignancy in the right nasal cavity of a 60-year-old man, a 22-French Foley was inserted to stem postoperative bleeding that failed to resolve with posterior nasal packing. A CT scan was obtained after the second attempt at passageof the Foley, revealing that the catheter had traversed the cribriform plate and left a pneumbcephaKc trail through the brain with traumatic hemorrhage seen Yin the right lateral ventricle and occipital lobe. On neurologic examination, the patient was confused and had a complete left homonymous hemianopia on confrontational visual fields. Brain imaging showed that the right optic tract was injured; the optic radiations, lateral geniculate, and occipital lobe were spared (figure). The patient was discharged home for outpatient radiation therapy for an undifferentiated si-nonasal carcinoma.Direct penetrating trauma to the brain is an unusual complication of catheter insertion to stanch bleeding from the nasal cavity.