Basilar skull fracture

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Background

  • involve at least one of five bones that comprise base of the skull [1]
    • cribiform 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 hematomas

Clinical Features

  • Nausea or vomiting, oculomotor deficits from injuries to CN3, 4 or 6
  • Retroauricular or mastoid ecchymosis (Battle sign), see 1-3 days after fracture ocurred
  • 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

Evaluation

  • Noncontrast CT head

Management

  • immediate neurosurgical consultation

Disposition

  • Admit for observation regardless of need for surgical intervention

See Also

References

  1. ↑ 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
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