Danny Adam

Introduction & aims

The oculocardiac reflex is activated by blunt orbital trauma leading to nausea, vomiting, bradycardia and gastric hyper motility. Here we present an important case of a child misdiagnosed with a head injury. We carried out a literature search to review the current information available to the surgical and medical team, and suggestions to improve knowledge of this important differential.

Methods

We present a case report of a child who was diagnosed as a head injury due to vomiting post head injury. He was admitted from the emergency department to the paediatric ward for observation where he continued to have symptoms of the oculcardiac reflex. Even initial CT scan crucially missed off the orbital floor entrapment, delaying the diagnosis. It was not until surgery was performed that the patients symptoms resolved. We carried out a full literature search to assess what information is available for our medical colleagues.

Results

This shows an important case of how a child maybe easily misdiagnosed as a head injury following blunt orbital trauma. On reviewing the literature, the majority of articles are published in OMFS, ophthalmic and anaesthetic journals. There is limited information available for the physician.

Conclusions

The oculcardiac reflex is an extremely important differential for any head trauma, especially blunt trauma to the mid third of the face. In addition it shows the importance of full imaging in this patient group. A literature search shows that evidence is mainly focused in surgical and anaesthetic journals. It is suggested we take the time, locally, to train emergency and paediatric doctors, about this important differential diagnosis of a head injury.

Information

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