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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

Basilar Skull Fracture

SYMPTOMS/EXAM

■ A linear fracture at the base of the skull (longitudinal are the most common)

■ Clinical findings include: Battle sign, raccoon eyes, hemotypanum (80%),

and CSF rhinorrhea or otorrhea (15%) (see Figure 14.8).

■ CSF rhinorrhea may be increased with jugular compression or leaning

forward. The ring or halo sign seen on filter paper or bed sheet refers to an

area of fluid beyond an area of blood and indicates the presence of CSF

(not just snot).

■ Additional testing for CSF includes fluid glucose (elevated compared to

tears or nasal secretions) or B2 transferrin (most specific).

DIAGNOSTICS

■ Skull X-ray positive in <50% (no longer used)

■ CT scan with 1- to 3-mm cuts

TREATMENT

■ ENT/neurosurgery consult

■ Prophylactic antibiotics may be given, although there is not conclusive

evidence that prophylaxis decreases rates of meningitis.

■ Most fractures are nondisplaced and heal without surgical intervention.

FIGURE 14.8. Battle sign: Ecchymosis on the mastoid area.

(Courtesy of Frank Birinyi, MD as published in Knoop KJ, Stack LB, Storrow AB. Atlas of

Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:4.)