Basilar skull fracture

Background

• Involve at least one of five bones that comprise base of the skull
  • cribriform plate of ethmoid bone
  • orbital plate of the frontal bone
  • petrous and squamous portion of the temporal bone
  • sphenoid and occipital bones
• Occur most commonly through temporal bone--> high risk for extra-axial hematomas, particularly epidural hematoma

Clinical Features

Raccoon eyes

• Nausea/vomiting, oculomotor deficits from injuries to CN3, 4 or 6
• Retroauricular or mastoid ecchymosis (Battle sign), onset 1-3 days after fracture occurred
• Raccoon eyes: periorbital ecchymosis
• Clear rhinorrhea or otorrhea
  • "halo" sign: drop of fluid placed on tissue or filter paper, rapidly expanding ring of clear fluid around red blood defines positive test
  • CSF distinguished from local nasal secretions with presence of beta-trace protein or beta-2 transferrin
• Hemotympanum

Differential Diagnosis

Head trauma

• Traumatic brain injury
  • Intracranial hemorrhage
    • Intra-axial
      • Traumatic intracerebral hemorrhage
    • Extra-axial
      • Epidural hemorrhage
      • Subdural hemorrhage
      • Subarachnoid hemorrhage
  • Moderate-to-severe traumatic brain injury
    • Elevated intracranial pressure
  • Mild traumatic brain injury
    • Clinical decision rules for head CT in trauma
    • Post-concussive syndrome
• Orbital trauma
• Maxillofacial trauma
• Scalp laceration
• Skull fracture
  • Basilar skull fracture
  • Skull fracture (peds)
• Pediatric head trauma
  • PECARN head trauma rule

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Evaluation

• Noncontrast CT head

Management

• Immediate neurosurgical consultation

Disposition

• Admit for observation regardless of need for surgical intervention

See Also

• Skull Fracture