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.

CAT scan

Computed Axial Tomography (CAT scan) is a process of using computers to generate three dimensional images from a flat two dimensional X rays pictures through the 'slice' technique. Aided by computer, cross-sectional views are generated and if needed three dimensional images of the internal organs and structures of the body. In CAT scan the body is seen in 'slices' from the skin to the central part of the body. When all the levels (slices) are added together, a three dimensional picture of an organ is obtained. Together the cross sections give a very accurate picture of where the tumor is and how big or small it is. They also show how close the major body organs are to the area that needs to be treated or operated upon. A CAT scan can be used to define both the normal and abnormal structures the body. It also helps as an accurate guide in placement of instruments and treatments for undergoing procedures.

• The head is examined for trauma injuries, such as blood clots or skull fractures.
  
• Spine is studied for any infections and to check the anatomy of intervertebral discs and spinal cord.
  
• Density of the bone in evaluating osteoporosis is also accurately measured by CAT scan.
  
• CAT scans are used in the chest to identify tumors, cysts or infections.
  
• CAT scans of the abdomen are helpful in defining body organ anatomy, including visualizing liver, gall bladder, pancreas, spleen, aorta, kidneys, uterus and ovaries. Also CAT scans help to verify the presence or absence of tumors, infection, abnormal anatomy or changes in the body from trauma.
  
• CAT scans help to guide the radiologist in performing certain procedures such as biopsyand suspected cancers, removal of internal fluids for various tests.

Many of the procedures in CAT scan are minimally invasive. CAT scan is very low risk procedure. The amount of radiation in CAT scan is very minimal. Unlike MRI, CT scans can be done even if the patient has a pace maker or an internal cardioverter defibrillator devices implanted into the chest to help regulate the heart beat. CAT scan may pose a potential risk to the fetus during the first trimester of pregnancy. Sometimes in contrast studies using iodine-based, there may be itching, a rash, hives or a feeling of warmth throughout the body. But these reactions tend to go away quickly. Very rarely does a more serious reaction occur during intravenous contrast studies. This anaphylactic reaction results in severe hives and/or difficulty in breathing.

Benefits of CAT Scan

• Diagnose muscle and bone disorders such as bone tumors and fractures
  
• Pinpoint the location of tumor, infection and blood clot
  
• Guide certain procedures in surgery
  
• Detect and monitor diseases such as cancer or heart disease
  
• Detect internal injuries and internal bleeding.
  

Battles sign

The term Battle's Sign indicates the condition of fracture at the base of the posterior portion of the skull. The sign, which takes its name after William Henry Battle is suggestive of brain trauma. The sign indicates bruising immediately behind the person's ears. A bloody drainage occurs from the ear immediately after the fracture has occurred.

In case of brain fracture or bruises, along with bleeding in the ear, other complications, such as bleeding from nose and eyes, facial swelling, bleeding or bruising, unconsciousness, convulsions, multiple injuries and distress may occur. Battle's sign is indicative external sign of a trauma or fracture of the skull inside. Such skull fractures are common in children. They occur due to the following causes:

• Head trauma
  
• Falls
  
• Automobile accidents
  
• Physical assault
  
• Sports