Basilar skull fracture

If there is a fracture or break in the cranial or skull bones, it is called a skull fracture. When the base of the skull is involved in a head injury, it is a basilar skull fracture or basal skull fracture. It is also known as depressed skull fracture and linear skull fracture. This linear fracture is rare and occurs in only 4% of patients with severe head injury. Falls, injuries caused by penetrating external objects like knives, hammers or axe or gunshot wounds may result in skull fractures. It can also occur when the skull hits a solid object with considerable force. Basilar skull fracture can be called a linear fracture at the base of the skull. Usually, dural tear is associated with this type of fracture. This fracture occurs at specific points on the skull base. While analyzing skull fractures, it is seen that 19-221% of all skull fractures happen to be basilar skull fractures.

There may be a traumatic brain injury when the skull is fractured. The area of the brain injured and the severity of injury is diagnosed by examining the fracture. If bacteria enter inside the skull through this fracture of the skull, it will lead to infection. Sudden blow to the back of the head can also result in a basilar skull fracture.

After a head injury, if there is a leak of a clear fluid from the nose or ears, it indicates that the clear fluid is cerebrospinal fluid (CSF) that surrounds the brain. CSF drains out through the ears or nose, when the skull is fractured and the Meninges or the covering of the brain is torn. The typical nasal drainage due to allergies, cold or crying is different from this drainage of CSF. It is also an indication of a fracture of the frontal bone or the base of the skull i.e. sphenoid or temporal bone or of the ethmoid bones (bones that support the nose and sinuses).

If bleeding from the ears or nose is not due to a cut or a direct blow, it may be an indication of a fracture of the base of the skull. Determine the cause of the bleeding by washing the blood thoroughly and see if the bleeding is from a cut or not. Ascertain the source of bleeding from the ear. It is an indication of a skull fracture if a nose bleed does not stop with home treatment. If bruising or dislocation develops within 24 hours after a head injury, it also indicates a basilar skull fracture. Often bleeding within the skull may occur with a basilar skull fracture. This condition may lead to infection.

• Battle's sign-bruising behind one ear.
  
• Raccoon eyes-bruising around both eyes.
  
• Abnormalities pertaining to vision.
  
• Weakness of facial muscles.
  
• Problems in hearing.
  
• Difficulties in smelling.
  
• Nasal drip due to leaking of cerebral spinal fluid.

Diagnosis is made with laboratory check of the clear dripping fluid for the presence of CSF. A CT scan of the head with the focus on bones can reveal the extent of damage to the bones. CSF otorrhea and bruising over the mastoids commonly known as 'battle sign' is an indication of a fracture of the petrous temporal bone. Rhinorrhea and bruising around the eyes (raccoon eyes) are noticed with anterior cranial fossa fractures. Depending on an associated intracranial pathologic condition, the Glasgow Coma Score and loss of consciousness may differ from patient to patient. Temporary deafness is a possibility but it resolves in about three weeks.

Hemotympanum and mucosal edema in the middle ear fossa cause this temporary hearing loss. Basilar skull fractures sometimes leads to meningitis in some patients. If the bones around the foramen magnum are broken, there is a risk of damage to the blood vessels and nerves exiting the hole.

Labyrinthitis

A patient suffering from Labyrinthitis experiences severe vertigo and subsequent dizziness and imbalance. There is disequilibrium and spinning attacks. Labyrinthitis is a mild condition that is caused by viral or bacterial infection. Often this condition follows a bout of cold and flu or allergy or drugs that are toxic to the inner ear. It occurs when there is an inflammation in the labyrinth of the ear. Since the sense of balance and hearing hinge on the delicate structure of the inner ear, any dysfunction can lead to symptoms associated with labyrinthitis. Usually the symptoms pass away in a few weeks. However, a severe case of Labyrinthitis can damage your sense of balance and hearing.

Labyrinthitis manifests with symptoms such as lightheadedness, imbalance and feeling of being pushed either forwards, backwards or sideways. There may be nausea, fatigue and reduced immunity. Labyrinthitis may bring on uncontrollable flickering of the eyes and momentary deafness. A patient suffering from Labyrinthitis is likely to face problems with memory and thinking abilities. Depression and anxiety may also set in.

A physician will conduct a physical examination to check for dizziness and vertigo. Antibiotics are prescribed for bacterial infections. Hearing and eye tests may be conducted in severe cases. A mild case of Labyrinthitis lasts for a couple of weeks.

• Take good rest
  
• Drink plenty of water
  
• Reduce bright lights, noise and stress around you
  
• Reduce intake of salt and sugar
  
• Avoid smoking, caffeine, alcohol and chocolate
  

Neurofibromatosis

Neurofibromatosis is a broad term used for three different genetic disorders all of which result in tumors on the tissues of the nerves. These tumors can occur anywhere on the nervous system, or beneath the skin or on the bones. It may also form on the eye. Neurofibromatosis is normally diagnosed in early childhood. In most cases, children inherit the defective mutated genes from their parents. However in certain cases it occurs through spontaneous mutation.

Neurofibromatosis (NF1)

NF1, also known as Von Recklinghausen, is the most common type of Neurofibromatosis. NF1 can lead to symptoms ranging from mild to very severe. Some of the distinctive signs of Neurofibromatosis Type 1 include:

• Au-lait spots (brown spots)
  
• Freckles in the armpit, groin, other skin folds
  
• Neurofibromas on or under the skin throughout the body
  
• Deformation of bones
  
• Big sized head and short stature
  
• Scoliosis
  
• Learning disabilities
  
• High blood pressure
  
• Tumors on the iris of the so called Lisch nodules
  
• Tumors on the optic nerve.

Physical examination and family history of the patient form the basis of the diagnosis of Neurofibromatosis Type1. Imaging tests such as x-ray, CT scan and MRI may also be ordered along with skin biopsy to confirm the diagnosis.

There is no cure for NF1; patients have to be monitored carefully on a regular basis to check for any sort of complications. Surgery is advised if the tumors are causing malformed bones. In very rare cases, the tumors become cancerous. Like any other cancers, these tumors are surgically removed and treated with chemotherapy or radiation.

Neurofibromatosis Type 2

Neurofibromatosis Type 2 is rare compared to NF1 and is characterized by multiple tumors on the cranial nerve that controls hearing and balance. These tumors are known as Vestibular Schwannomas and give rise to deafness and balance problems. Tumors may also develop on the spinal nerve and other peripheral nerves that control swallowing, speech, eye movements and facial sensations and eventually hamper their effective functioning. Patient may also develop weakness, numbness, or tingling in an arm or leg.

The symptoms of NF2 typically start in the teens or early twenties. Hearing loss beginning during adolescence is the first and most distinctive feature of Neurofibromatosis Type 2. Cataract that starts at an early age is also a strong indicator of NF2. Similar to NF1, NF2 is also caused by defective gene mutation.

There is no cure for NF2; however patients will be treated symptomatically. Regular monitoring of ear and eye functions is carried out to understand any further deterioration. MRI is advised at frequent intervals to assess the size of the tumors. If the tumors are growing in size, they may be removed surgically or shrunk through radiation.

Schwannomatosis

Schwannomatosis is a rare form of Neurofibromatosis and it varies from NF1 and NF2 genetically and clinically. This condition causes tumors on nerves of the brain and spinal cord and nerves in the arms and legs. However Schwannomatosis never causes tumors on the vestibular nerve. Intense pain is a characteristic feature of Schwannomatosis. As tumors press on the nerves and tissues pain, numbness or tingling occurs in the affected parts of the body. There is no definite treatment for Schwannomatosis. Treatment plan includes pain management through medications and regular monitoring of the size of the tumors. Not all the tumors are ideal for surgical removal due to their delicate location. If it is feasible, surgical removal of tumors is the most effective method to manage pain.