Subarachnoid hemorrhage and vasospastic stroke after self-enucleation.

A 31-year-old intoxicated woman self-enucleated her left eye during an acute psychotic episode. CT revealed avulsion of the intracranial optic nerve, chiasmal edema, and adjacent subarachnoid hemorrhage. Exploration via transconjunctival orbitotomy was performed, and the globe and 4.8 cm of contiguous optic nerve were removed. The patient developed postoperative contralateral visual loss followed by middle cerebral artery vasospasm and bilateral cortical infarcts.