An 11-year-old boy re-presented with refractory vomiting 18 h after blunt facial and head trauma. Initial CT of the brain performed at his first visit was normal. He was found to have a heart rate of 56 bpm (age appropriate 65–100 bpm) with a blood pressure 90/60 mm Hg. Physical examination revealed an injected sclera and limited vertical movement of the left eye. Neurological examination revealed no focal deficits, but a Glasgow Coma Scale of 14, with mild confusion, depressed mental status and diplopia on upward gaze. Performing upward gaze extra ocular movements exacerbated the patient's bradycardia and confirmed the presence of the oculocardiac reflex. High-resolution CT of orbits demonstrated a left orbital floor fracture with entrapment of the left inferior rectus muscle. Surgical correction resolved his bradycardia.
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机译：一个11岁的男孩在面部和头部受到钝伤后18小时出现了顽固性呕吐。在他的第一次就诊时进行的脑部初步CT正常。发现他的心律为56 bpm（年龄在65-100 bpm之间），血压为90/60 mm Hg。体格检查发现巩膜已注射，左眼垂直运动受限。神经系统检查未发现局灶性缺陷，但格拉斯哥昏迷量表为14，伴有轻度意识模糊，精神状态低落和向上凝视的复视。进行向上注视时，眼外运动会加重患者的心动过缓，并确认存在眼心反射。眼眶的高分辨率CT显示左眼底骨折并伴有左下直肌。手术矫正解决了他的心动过缓。
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