![]() ![]() ![]() Clinical Signs of Basilar Skull Fracture and Their Predictive Value in Diagnosis of This Injury. Solai CA, Domingues C de A, Nogueira L de S, de Sousa RMC.Skull base fractures and their complications. Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma. Tunik MG, Powell EC, Mahajan P, et al.Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury. Alhelali I, Stewart TC, Foster J, et al.Traumatic skull fractures in children and adolescents: A retrospective observational study. Wang H, Zhou Y, Liu J, Ou L, Han J, Xiang L.Potapov AA, Gavrilov AG, Kravchuk AD, et al.The majority of CSF leaks resolve within one week without complication. Fluid can be collected and analyzed for the presence of ß transferrin which is only found in cerebrospinal fluid. The leaks may develop one to many days after the initial injury. ![]() CSF otorrhea (A) is another concerning sign for a basilar skull fracture, but is often difficult to diagnose. Mastoid ecchymosis, also known as Battle sign (C) and periorbital ecchymosis, known as raccoon eyes (D) are both signs concerning for a basilar skull fracture, but are not commonly seen during the acute evaluation as they take 1-3 days to appear. The decision to give prophylactic antibiotics in patients with evidence of a CSF leak is somewhat controversial and should be made in conjunction with the neurosurgeon. ![]() Neurosurgical consultation and admission is warranted. Diagnosis is made via noncontrast CT of the head. Other symptoms include evidence of a CSF leak, mastoid ecchymosis (Battle’s sign), periorbital ecchymosis (raccoon eyes), vertigo, decreased hearing, and seventh nerve palsy. The tympanic membrane will appear blue to purple in color. Hemotympanum is the most frequent finding on physical examination. Given the close proximity of these fractures to the middle meningeal artery, patients are also at increased risk for extra-axial hematomas, particularly epidural hematomas. The presence of a leak provides a means for introduction of infection putting these patients at increased risk for development of meningitis. There can be an associated dural tear leading to cerebrospinal fluid (CSF) otorrhea or rhinorrhea. The most common basilar skull fracture involves the petrous portion of the temporal bone, the auditory canal, and the tympanic membrane. Which of the following signs or symptoms is seen most frequently in the initial evaluation of a patient with a basilar skull fracture?īasilar skull fractures are linear fractures that occur anywhere along the skull base from the cribriform plate to the occipital condyles. No indication for prophylactic antibiotics in basilar skull fracture to prevent meningitis 22.Nasogastric tube placement is contraindicated with potential for intracranial placement.Discharge criteria for isolated basilar skull fracture in pediatric patient: normal neuro exam after NCHCT and successful observation.Head CT is crucial even in the absence of clinical evidence.Carotid cavernous fistula, is a rare, but feared complication in middle fossa fractures, especially oblique or transverse, causing exophthalmos, blindness, CVA, and death 26.In BSFs involving vascular complications of carotid, 31% of patients with dissection will have a CVA as a result, stressing the importance of imaging with angiography 25.Many resolve on their own spontaneously.Glucocorticoids and ENT consultation 24.Common complication is traumatic facial nerve palsy 24.Hemodynamic goals: SBP> 100 mmHg if 50-69 years old, SBP>110 if 15-49 years old or >70 years old (per Brain Trauma Guidelines) 15.18% of basilar skull fractures have CSF leakage, with degree of fracture and leakage correlating with injury severity 1.Generated by blunt head or facial trauma.What’s the next step in your evaluation and treatment?Īnswer: Basilar skull fracture (BSF) 1-26 Pertinent physical examination reveals hemotympanum, serosanguineous discharge bilaterally from the nares, and CN III palsy. Another passenger reports that the patient hit his head on the seat in front of him. The patient was restrained, there was no intrusion, and airbags deployed with the car traveling at 50 mph. A 19-year-old male is brought to the ED by EMS status post MVC with a C-collar in place. ![]()
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