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An elderly woman with bilateral raccoon eyes
  1. Ryota Inokuchi1,2,
  2. Shunsuke Tagami1,2,
  3. Hiromu Maehara1,2
  1. 1 Department of Emergency Medicine, JR General Hospital, Tokyo, Japan
  2. 2 Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
  1. Correspondence to Dr Ryota Inokuchi, Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; inokuchir-icu{at}h.u-tokyo.ac.jp

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Clinical introduction

A 65-year-old woman presented with head and facial trauma after a fall from standing height. Her vital signs were normal, and physical examination revealed right-sided facial contusions and bilateral periorbital ecchymoses (ie, a raccoon sign or panda eyes) (figure 1). She denied a headache and orbital pain. Head computed tomography (CT) was performed, but no skull fracture, periorbital haematoma, encephalorrhagia, punched-out lesion or tumour was detected. Laboratory data indicated kidney dysfunction. The patient reported that the non-painful periorbital skin lesion developed over a period of 1–2 years.

Figure 1

Right-sided facial …

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