Tsuboguchi Shintaro, Okamoto Kouichirou, Tokiguchi Susumu
Department of Neurology, Ojiya General Hospital, Ojiya, Japan.
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Surg Neurol Int. 2025 Jul 11;16:286. doi: 10.25259/SNI_229_2025. eCollection 2025.
Traumatic raccoon sign (periorbital ecchymosis) typically results from facial or severe head trauma involving anterior skull base fractures. In contrast, contrecoup raccoon signs arising from minor posterior head injuries are extremely rare, particularly in older adults. In addition, spontaneous, nontraumatic raccoon signs may be associated with focal or systemic conditions, including malignancies, necessitating extensive diagnostic evaluation. Distinguishing between traumatic and nontraumatic causes is crucial in older patients presenting with raccoon sign following minor head trauma, especially when neurological deficits and visible external injuries are absent.
An 85-year-old male with a 30-year history of insulin-treated type 2 diabetes presented with raccoon sign one morning, without additional symptoms. A comprehensive physical examination, including a detailed head assessment, revealed no abnormalities. However, computed tomography (CT) imaging identified a minor subarachnoid hemorrhage, and high-resolution CT imaging (1-mm bone slice thickness) detected a thin orbital roof fracture, confirming a traumatic contrecoup injury. This finding rendered the differential diagnosis for nontraumatic causes irrelevant. The patient's longstanding diabetes was considered a relevant factor in the development of the raccoon sign.
In older adult patients presenting with raccoon sign but lacking overt symptoms, obtaining a thorough history of head trauma and diabetes is essential, even in cases of minor injury without visible external signs. High-resolution thin-slice bone CT imaging is vital for detecting subtle orbital roof fractures, which may otherwise go unnoticed. Early identification facilitates accurate diagnosis and prevents unnecessary evaluations for nontraumatic causes.
创伤性浣熊眼征（眶周瘀斑）通常由涉及前颅底骨折的面部或严重头部创伤引起。相比之下，因轻微头部后部损伤导致的对冲性浣熊眼征极为罕见，尤其是在老年人中。此外，自发性、非创伤性浣熊眼征可能与局部或全身性疾病有关，包括恶性肿瘤，这需要进行广泛的诊断评估。对于轻微头部创伤后出现浣熊眼征的老年患者，区分创伤性和非创伤性病因至关重要，特别是在没有神经功能缺损和明显外部损伤的情况下。
一名85岁男性，有30年胰岛素治疗2型糖尿病病史，某天早晨出现浣熊眼征，无其他症状。全面的体格检查，包括详细的头部评估，未发现异常。然而，计算机断层扫描（CT）成像发现少量蛛网膜下腔出血，高分辨率CT成像（1毫米骨切片厚度）检测到眶顶薄层骨折，证实为创伤性对冲伤。这一发现使非创伤性病因的鉴别诊断变得无关紧要。患者长期患糖尿病被认为是浣熊眼征发生的一个相关因素。
对于出现浣熊眼征但无明显症状的老年患者，即使是轻微损伤且无明显外部体征的情况，获取详细的头部创伤和糖尿病病史也至关重要。高分辨率薄层骨CT成像对于检测细微的眶顶骨折至关重要，否则这些骨折可能会被忽视。早期识别有助于准确诊断，并避免对非创伤性病因进行不必要的评估。
