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Neuroblastoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
More than 40% of children with neuroblastoma have metastatic disease at diagnosis. These patients are often quite ill and have systemic symptoms caused by widespread disease. Neuroblastoma has a pattern of metastatic disease to the bone marrow, lymph nodes, and bone. These metastases may manifest as anemia from marrow infiltration, or bone pain and/or limp from cortical metastases. In very young patients, metastatic infiltration of the liver may result in hepatomegaly. Metastatic disease may be also associated with darkened eyes, referred to as “raccoon eyes,” resulting from retro-orbital venous plexus spread, or purple, subcutaneous nodules, referred to as “blueberry muffin” lesions.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Orbits Ocular dystopia, restricted eye movementExorbitism or enophthalmosPupil size and reactivityDiplopia/field defectsRaccoon eyes (anterior cranial fossa fracture)
Severe head injuries
Published in Brian Sindelar, Julian E. Bailes, Sports-Related Concussion, 2017
Brian Sindelar, Julian E. Bailes
Athletes with a diagnosis of a skull fracture rarely present asymptomatically, and will more often display focal tenderness, edema (swelling), bruising (ecchymosis), or a deformity overlying the fracture site. Specific clinical exam findings also may help point to the location of fracture. Patients may develop “raccoon eyes” (bilateral periorbital ecchymosis) or “battle’s sign” (ecchymosis behind the ear overlying the mastoid process) in the setting of basal skull fractures2 (Figure 4.1). Ultimate diagnosis of a skull fracture is determined through a skull x-ray or head CT (Figure 4.2).
Raccoon eyes in a newborn
Published in Fetal and Pediatric Pathology, 2022
Subgaleal hematoma develops due to birth trauma, when blood accumulates in the loose areolar tissue in the space between the periosteum and the aponeurosis. The subaponeurotic space extends anteriorly to the orbital margins and posteriorly to the nuchal ridge [2]. Neonates with subgaleal hemorrhage are at high risk for rapid decompensation with hypovolemic shock, including tachycardia, hypotension and acidosis. When subgaleal hemorrhage is not associated with hemodynamic instability, outcomes are usually very good [3]. Raccoon eyes are believed to be a common complication of basal skull fractures [4] or, in cases without a history of trauma, they are associated with systemic conditions such as neuroblastoma [5]. In this case, as the cerebral ultrasound, hematologic and coagulation studies were normal, these serious situations were excluded. At the follow-up on the DOL 38 the baby was thriving and raccoon eyes were no longer present. The correct interpretation of all related conditions avoided more unnecessary extensive evaluations and parental anxiety.