QuestionSBA
QuestionChoice
An open skull fracture is when the fracture has led to skin breakage, resulting in bone protruding. This patient has no scalp lacerations and there is no evidence of a compound fracture, therefore.
53213
b
Open skull fracture
QuestionChoice
Diastatic skull fractures are fractures that occur along suture lines, resulting in widening. They are usually seen in newborns and infants as their skull bones take time to develop.
53216
e
Diastatic skull fracture
QuestionChoice
A linear skull fracture is when there is a fracture without any movement or distortion of the bone. Hence, the fracture just appears as a thin line/crack in the skull. These are less serious than basal skull fractures, require observation only and do not usually require any surgical management. They are not associated with the characteristic features as in this case of a basal skull fracture, and rarely develop any complications.
53214
c
Linear skull fracture
QuestionChoice
Fractures of the skull base can occur following head injury sustained during road traffic accidents. The commonest location of these fractures is the petrous part of the temporal bone. Classical features are haemotympanum (bleeding behind the tympanic membrane), periorbital ecchymoses (raccoon eyes), bruising of the mastoid (Battle's sign) and rhinorrhea (due to CSF leakage.) Most require observation only, but in some cases surgical correction may be required, such as in the case of persistent CSF risk. Complications are serious, including meningo-encephalitis and cavernous sinus thrombosis.
53212
a
Basal skull fracture
QuestionChoice
A depressed skull fracture is when the bone sinks downwards towards the brain. These may require surgical intervention, especially if the underlying brain tissue is compressed. This patient is displaying classical features of a basal skull fracture, however, and so this is the most likely diagnosis at this stage. Furthermore, this patient's skull is reported as having a smooth contour, making any depressions unlikely.
53215
d
Depressed skull fracture
Concept
Chapter
# Summary

A base of skull fracture refers to a break in one or more bones at the base of the skull, typically the temporal bone but possible in the occipital, sphenoid, or ethmoid bones. Key signs and symptoms include reduced consciousness, bruising around the eyes or mastoid process, CSF leakage from the ear, cranial nerve palsy, and bleeding from the nose or ears. The primary investigation is a CT head scan. Management is based on the specific injury, often involving the management of raised intracranial pressure, potential neurosurgery and antibiotics for possible meningitis.

# Definition

- Base of skull fracture refers to the fracture of one or more bones at the base of the skull. These bones typically include the temporal bone, but can also be the occipital, sphenoid, or ethmoid bones.
- The anterior cranial fossa includes the superior sphenoid and ethmoid bones.
- The posterior cranial fossa comprises of the occipital, temporal, and part of the sphenoid bone.

# Epidemiology

- The exact prevalence of base of skull fractures is not well known due to the necessity of advanced imaging for diagnosis. However, it is a common occurrence in severe head injuries resulting from blunt force trauma.

# Aetiology

- Base of skull fractures are usually caused by severe head injury or blunt force trauma. This can occur from road traffic accidents, falls, assaults, or other forms of high-energy impact.

# Signs and symptoms

- History of severe head injury
- Reduced consciousness
- Battle's sign: bruising of the mastoid process
- Raccoon eyes: periorbital bruising
- Rhinorrhoea: CSF leakage from the nose
- Otorrhoea: CSF leaking from the ear
- Cranial nerve palsy
- Epistaxis or otorrhagia: Bleeding from the nose or ears
- Haemotympanum: blood visible behind the tympanic membrane

# Differential diagnosis

- Concussion: Symptoms include headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue.
- Intracranial hemorrhage: Signs may include severe headache, weakness, numbness, decreased alertness, and nausea or vomiting.
- Brain contusion: Symptoms can include headache, confusion, memory loss, reduced concentration, and in severe cases, unconsciousness.
- Skull fracture without base involvement: This may present with similar symptoms as a base of skull fracture; however, Battle's sign and raccoon eyes are typically absent.

# Investigations

- The principal investigation for a suspected base of skull fracture is a CT head scan. This imaging modality can highlight bone fractures and any associated intracranial injuries.

# Management

- Management of a base of skull fracture is dependent on the severity of the injury.
- Raised intracranial pressure is managed with medications, and in severe cases, surgery.
- Neurosurgery might be required depending on the extent of the injury.
- Antibiotics are administered if there is a risk of meningitis, especially in situations where there is CSF leakage. 

# External links

[- Radiopaedia: Base of Skull Fracture](https://radiopaedia.org/articles/base-of-skull-fracture?lang=gb)
[- BMJ Best Practice: Skull Fractures](https://bestpractice.bmj.com/topics/en-gb/398)
[- Life In The Fast Lane: Base of Skull Fractures](https://litfl.com/base-of-skull-fracture/)
[- Simon LV & Newton EJ. Basilar Skull Fractures](https://www.ncbi.nlm.nih.gov/books/NBK470175/)
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2322
Basal skull fracture
Topic
24
Ear, Nose & Throat
10703
A 23-year-old male presents to A&E via ambulance following a road traffic accident. On examination, there is bruising around the eyes and bleeding behind his tympanic membrane. There are no lacerations on his scalp and his skull has a smooth contour. His Glasgow Coma Score is 11. A CT head is requested.

Which of the following is the most likely diagnosis?
a