![]() The use of prophylactic antibiotics for meningitis is one area of controversy. Most post-traumatic CSF leaks heal with a conservative management of bed rest and head elevation. ![]() Management is based on anticipated complications. Recent studies have shown that maxillofacial CT and HRCT of the temporal bone are comparable and most suited for the diagnosis of temporal bone fracture.Īll patients with basilar skull fractures should be admitted for observation. 6 Basilar bone fractures (specifically temporal bone fractures) may also be missed on initial CT scan of the head. 2,4,5 Plain films may miss as many as 70-80% of fractures. The combination of hemotympanum and bloody otorrhea is 75% more common with temporal bone fractures than without fracture: for this reason hemotympanum and bloody otorrhea are ominous physical exam findings.Ĭlinical exam, however, has actually been shown to miss 14-35% of radiographically evident temporal bone fractures. Prior to the advent of high-resolution CT (HRCT) scanners, the diagnosis of temporal bone fractures was predominantly clinical. Conductive hearing loss, anosmia, nystagmus, and vomiting after head injury should also raise suspicion of a basilar skull fracture. Purple discoloration around the eyes, also known as “raccoon eyes,” can be the result of a fracture to the frontal portion of the skull base. Contrary to traditional teaching, this sign is not specific to CSF, and may result in false-positives.Įcchymosis over the mastoid process is known as Battle's sign and typically indicates a fracture of the posterior cranial fossa. In the absence of a TM perforation, hemotympanum may be seen on exam.Ĭerebrospinal fluid mixed with blood forms the halo sign when allowed to drip onto filter paper. 3Ĭerebrospinal fluid also accumulates in the middle ear space, and can ultimately expectorate through a perforated tympanic membrane and manifest as CSF otorrhea. 2 Traumatic cerebrospinal fluid (CSF) leaks occur in 10-30% of basilar skull fractures and most often present as CSF rhinorrhea. This predisposition is not related to any true anatomic differences, but to the greater number of males involved in high-risk activities. They are most common in men between the ages of 21 and 30. 1 Temporal bone fractures occur in 18-40% of all skull fractures. The temporal bone is involved in 75% of cases, but the occipital, sphenoid, and ethmoid bones may also be involved. ![]() Simply stated, a basilar skull fracture refers to any fracture found at the base of the skull. Subtle left temporal bone fracture, seen through the mastoid on CT imaging.
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