Differential Diagnosis for Raccoon Eyes in a 3-Year-Old Male After Trauma to the Forehead
- Single Most Likely Diagnosis
- Basilar skull fracture: This is the most likely diagnosis given the presentation of "raccoon eyes" (periorbital ecchymosis) following trauma to the forehead. The mechanism of injury can cause a fracture at the base of the skull, leading to blood tracking into the soft tissues around the eyes.
- Other Likely Diagnoses
- Orbital fracture: A direct blow to the forehead can also cause a fracture of the orbital bones, leading to periorbital ecchymosis. This would be less likely than a basilar skull fracture to cause "raccoon eyes" but is still a plausible explanation.
- Soft tissue injury: Significant soft tissue injury around the eyes and forehead could also lead to periorbital ecchymosis, although this might not fully explain the classic "raccoon eyes" appearance without an underlying fracture.
- Do Not Miss Diagnoses
- Intracranial hemorrhage: Although less directly related to the "raccoon eyes" sign, any significant head trauma warrants consideration of intracranial hemorrhage, which can be life-threatening and requires immediate diagnosis and treatment.
- Cerebrospinal fluid (CSF) leak: A basilar skull fracture can also lead to a CSF leak, which might not be immediately apparent but can have serious implications for infection and further neurological damage.
- Rare Diagnoses
- Le Fort fracture: While more commonly associated with facial trauma, a severe impact could potentially result in a Le Fort fracture, which might indirectly contribute to periorbital ecchymosis, though this would be less common in the context of "raccoon eyes" following forehead trauma.
- Neuroblastoma: In the absence of trauma, periorbital ecchymosis can be a sign of neuroblastoma metastasis to the orbits. However, in the context of recent trauma, this would be an extremely rare and unlikely diagnosis.