Basilar skull fracture

Background
Bones of the cranium.
  • 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
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

Maxillofacial Trauma

Evaluation
Temporal bone fracture as seen on CT.
CT showing basilar skull fracture
  • Noncontrast CT head

Management
  • Immediate neurosurgical consultation

Disposition
  • Admit for observation regardless of need for surgical intervention

See Also
  • Skull Fracture

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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