Basilar skull fracture: Difference between revisions
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==Background== | ==Background== | ||
* | [[File:Cranial bones en.png|thumb|Bones of the cranium.]] | ||
** | *Involve at least one of five bones that comprise base of the skull <ref> 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 </ref> | ||
**cribriform plate of ethmoid bone | |||
**orbital plate of the frontal bone | **orbital plate of the frontal bone | ||
**petrous and squamous portion of the temporal bone | **petrous and squamous portion of the temporal bone | ||
**sphenoid and occipital bones | **sphenoid and occipital bones | ||
* | *Occur most commonly through temporal bone--> high risk for extra-axial hematomas, particularly [[epidural hematoma]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Nausea | [[File:Bilateral periorbital ecchymosis (raccoon eyes).jpg|thumb|Raccoon eyes]] | ||
*Retroauricular or mastoid ecchymosis (Battle sign), | *[[Nausea/vomiting]], oculomotor deficits from [[cranial nerve palsies|injuries]] to CN3, 4 or 6 | ||
*Retroauricular or mastoid ecchymosis (Battle sign), onset 1-3 days after fracture occurred | |||
*Raccoon eyes: periorbital ecchymosis | *Raccoon eyes: periorbital ecchymosis | ||
*Clear rhinorrhea or otorrhea | *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 | **"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 | **CSF distinguished from local nasal secretions with presence of beta-trace protein or beta-2 transferrin | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Head trauma DDX}} | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:Tempbonefract.png|thumb|Temporal bone fracture as seen on CT.]] | |||
[[File:BasSkullFracMark.png|thumb|CT showing basilar skull fracture]] | |||
*Noncontrast CT head | *Noncontrast CT head | ||
==Management== | ==Management== | ||
* | *Immediate neurosurgical consultation | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Skull Fracture]] | *[[Skull Fracture]] | ||
==External Links== | |||
*Pillai, Saran S. Basilar Skull Fracture: Basics & Beyond available at http://www.emdocs.net/basilar-skull-fracture-basics-beyond/ | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Trauma]] | ||
Latest revision as of 17:15, 31 December 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
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- 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
External Links
- Pillai, Saran S. Basilar Skull Fracture: Basics & Beyond available at http://www.emdocs.net/basilar-skull-fracture-basics-beyond/
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