Intracranial Injury Caused by Transorbital Penetrating Trauma: An E-Scooter Brake Handle as an Unusual Culprit

Abstract

Transorbital penetrating intracranial injuries are a rare but life-threatening subset of penetrating head traumas. While isolated cases caused by bicycle brake handles have been reported, often with fatal outcomes, this is the first documented case of such an injury caused by an electric scooter (e-scooter) brake handle. The objective is to present the unique management and clinical course of this unusual case. A case of a 76-year-old male is presented. The patient sustained a transorbital intracranial injury after a same-level fall onto a parked e-scooter, which resulted in the brake handle penetrating his left orbit and reaching the third ventricle. A combined maxillofacial and neurosurgical team performed a frontal craniotomy for foreign body removal, followed by duraplasty. No cerebrospinal fluid leakage was detected postoperatively. Imaging and clinical follow-up at six months and one year revealed significant post-traumatic encephalomalacia in the frontal lobes, ventricular enlargement, and persistent neurocognitive deficits, including memory impairment and executive dysfunction. Visual acuity in the affected eye was reduced, with associated orbital fat atrophy and mild ptosis. E-scooter brake handles pose a previously unrecognized risk for severe transorbital penetrating intracranial injuries. This case underscores the critical importance of a multidisciplinary surgical approach to manage complex craniofacial trauma. Despite successful acute management, patients can suffer substantial long-term neurological and functional sequelae, necessitating comprehensive follow-up care.