Diferencia entre revisiones de «Basilar skull fracture»
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Head trauma DDX}} | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
Revisión del 04:55 28 ago 2019
Background
- Involve at least one of five bones that comprise base of the skull [1]
- 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
- 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
- Extra-axial
- Moderate-to-severe traumatic brain injury
- Mild traumatic brain injury
- Intracranial hemorrhage
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Noncontrast CT head
Management
- Immediate neurosurgical consultation
Disposition
- Admit for observation regardless of need for surgical intervention
See Also
References
- ↑ Golfinos JG, Cooper PR. Skull fracture and post-traumatic cerebrospinal fluid fistula. In:Head Injury, 4th, Cooper PR, Golfinos JG (Eds), McGraw-Hill, New York 2000. p.155