Basal Skull Fracture

The dura is firmly adherent to the base of the skull and hence any forms of fracture to the base of the skull can cause tearing of the dura and CSF leakage, and the potential for air to enter the cranial cavity (pneumocephalus). Both of these complications are risk factors for potential of CNS Infection.

Axial CT Scan showing longitudental fracture through the base of the skull- the temporal bones. Note the presence of the mastoid air cells.

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Clinical Signs

Headache

Battle’s sign (brusing behind the mastoid)

Peri-orbital ecchymosis

CSF Rhinorrhea

CSF Otorrhea/Haemotympanum

Management

The management involves Monitoring for complications such as

CSF Fistula

Meningitis

Cerebral Abscess

Neurological Injury- note the petrous temporal bone containing the 7th and 8th nerve

There is no evidence suggesting prophylactic use of antibiotics with a basal skull fracture

A ‘Pneumovax’ vaccine is given with¬† basal skull fractures. Note the organism in this case is Streptococcus Pneumonia NOT Neisseria Meningitis.

If suspected ethmoid fracture don’t insert a Nasopharyngeal tube or an Nasogastric tube