Basilar skull fracture
|Basilar skull fracture|
|Classification and external resources|
A subtle temporal bone fracture as seen on CT in a person with a severe head injury
Such fractures can cause tears in the membranes surrounding the brain, or meninges, with resultant leakage of the cerebrospinal fluid (CSF). The leaking fluid may accumulate in the middle ear space, and dribble out through a perforated eardrum (CSF otorrhea) or into the nasopharynx via the eustachian tube, causing a salty taste. CSF may also drip from the nose (CSF rhinorrhea) in fractures of the anterior skull base, yielding a halo sign. These signs are pathognomonic for basilar skull fracture.
Signs and symptoms
- Battle's sign - is ecchymosis of the mastoid process of the temporal bone.
- Raccoon eyes - is periorbital ecchymosis i.e. "black eyes"
- Cerebrospinal fluid rhinorrhea
- Cranial nerve palsy
- Bleeding from the nose and ears
- conductive or perceptive deafness, nystagmus, vomitus
- In 1 to 10% of patients, optic nerve entrapment occurs: the optic nerve is pressed by the broken skull bones, causing irregularities in vision.
- Serious cases usually result in death
Basilar skull fractures include breaks in the posterior skull base or anterior skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The temporal bone fracture is encountered in 75% of all basilar skull fractures and may be longitudinal, transverse or mixed, depending on the course of the fracture line in relation to the longitudinal axis of the pyramid.
Bones may be broken around the foramen magnum, the hole in the base of the skull through which the spinal cord exits and becomes the brain stem, creating the risk that blood vessels and nerves exiting the hole may be damaged.
Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get meningitis. Unfortunately, the efficacy of prophylactic antibiotics in these cases is uncertain.
Temporal bone fractures
Acute injury to the internal carotid artery (carotid dissection, occlusion, pseudoaneurysm formation) may be asymptomatic or result in life-threatening hemorrhage. They are almost exclusively observed when the carotid canal is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.
Society and culture
Basilar skull fractures are a common cause of death in many motor racing accidents. Drivers who have died as a result of basilar skull fracture include Formula One drivers Roland Ratzenberger and Ayrton Senna, Indianapolis 500 drivers Bill Vukovich, Tony Bettenhausen, Floyd Roberts, and Scott Brayton, NASCAR drivers Dale Earnhardt Sr., Adam Petty, Tony Roper, Kenny Irwin, Jr., Neil Bonnett, John Nemechek, J. D. McDuffie, and Richie Evans, CART drivers Jovy Marcelo, Greg Moore and Gonzalo Rodriguez, and ARCA drivers Blaise Alexander and Slick Johnson.
To prevent this injury, all major motor sports sanctioning bodies now mandate the use of head and neck restraints, such as the HANS device.
- Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
- Orlando Regional Healthcare, Education and Development. 2004. "Overview of Adult Traumatic Brain Injuries." Retrieved on January 16, 2008.
- Singh J and Stock A. 2006. "Head Trauma." Emedicine.com. Retrieved on January 26, 2007.
- Brain Injury Association of America (BIAUSA). "Types of Brain Injury." Retrieved on January 26, 2007.
- Ratilal, BO; Costa, J, Sampaio, C, Pappamikail, L (2011 Aug 10). "Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures.". Cochrane database of systematic reviews (Online) (8): CD004884. doi:10.1002/14651858.CD004884.pub3. PMID 21833952.
- Dagi TF, Meyer FB, Poletti CA (November 1983). "The incidence and prevention of meningitis after basilar skull fracture". Am J Emerg Med 1 (3): 295–8. PMID 6680635.
- Resnick DK, Subach BR, Marion DW (1997). "The Significance of Carotid Canal Involvement in Basilar Cranial Fracture". Neurosurgery 40 (6): 1177–1181.