A basilar skull fracture is a break of a bone in the

base of the skull The base of skull, also known as the cranial base or the cranial floor, is the most inferior area of the skull. It is composed of the endocranium and the lower parts of the calvaria. Structure Structures found at the base of the skull are for ...

. Symptoms may include bruising behind the ears, bruising around the eyes, or blood behind the ear drum. A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and may result in fluid leaking from the nose or

ear An ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists of ...

Meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

occurs in about 14% of cases. Other complications include injuries to the

cranial nerve Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and ...

s or blood vessels. A basilar skull fracture typically requires a significant degree of trauma to occur. It is defined as a fracture of one or more of the temporal,

occipital The occipital bone () is a cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone overlies the occipital lobes of the cereb ...

, sphenoid,

frontal Front may refer to: Arts, entertainment, and media Films * ''The Front'' (1943 film), a 1943 Soviet drama film * ''The Front'', 1976 film Music * The Front (band), an American rock band signed to Columbia Records and active in the 1980s and e ...

ethmoid bone The ethmoid bone (; from grc, ἡθμός, hēthmós, sieve) is an unpaired bone in the skull that separates the nasal cavity from the brain. It is located at the roof of the nose, between the two orbits. The cubical bone is lightweight due to a ...

. Basilar skull fractures are divided into

anterior fossa The anterior cranial fossa is a depression in the floor of the cranial base which houses the projecting frontal lobes of the brain. It is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and fr ...

middle fossa The middle cranial fossa, deeper than the anterior cranial fossa, is narrow medially and widens laterally to the sides of the skull. It is separated from the posterior fossa by the clivus and the petrous crest. It is bounded in front by the po ...

and posterior fossa fractures.

Facial fractures Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures ...

often also occur. Diagnosis is typically by CT scan. Treatment is generally based on the extent and location of the injury to structures inside the head. Surgery may be performed to seal a CSF leak that does not stop, to relieve pressure on a cranial nerve or repair injury to a blood vessel. Prophylactic antibiotics do not provide a clinical benefit in preventing meningitis. A basilar skull fracture occurs in about 12% of people with a severe

head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...

Signs and symptoms

Bilateral periorbital ecchymosis (raccoon eyes)

Battle's sign Battle's sign, also known as mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull. These fractures may be associated with underlying brain trauma. Battle's sign consists of bruising over the mastoid process as a r ...

–

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

of the

mastoid process The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has openings for blood vessels. From its borders, t ...

of the temporal bone. *

Raccoon eyes Raccoon eyes (also known in the United Kingdom and Ireland as panda eyes) or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Bilateral hemorrha ...

– bruising around the eyes, i.e. "

black eye A periorbital hematoma, commonly called a black eye or a shiner (associated with boxing or stick sports such as hockey), is bruising around the eye commonly due to an injury to the face rather than to the eye. The name refers to the dark-colo ...

s" *

Cerebrospinal fluid rhinorrhea Cerebrospinal fluid rhinorrhoea (CSF rhinorrhoea) refers to the drainage of cerebrospinal fluid through the nose ( rhinorrhoea). It is typically caused by a basilar skull fracture, which presents complications such as infection. It may be diagnosed ...

Cranial nerve Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and ...

palsy Palsy is a medical term which refers to various types of paralysisDan Agin, ''More Than Genes: What Science Can Tell Us About Toxic Chemicals, Development, and the Risk to Our Children;; (2009), p. 172. or paresis, often accompanied by weakness a ...

* Bleeding (sometimes profuse) from the nose and ears * Hemotympanum * Conductive or perceptive

deafness Deafness has varying definitions in cultural and medical contexts. In medical contexts, the meaning of deafness is hearing loss that precludes a person from understanding spoken language, an audiological condition. In this context it is written ...

nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

* In 1–10% of patients,

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

entrapment occurs. The optic nerve is compressed by the broken skull bones, causing irregularities in vision. * Serious cases usually result in

death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...

Pathophysiology

Basilar skull fractures include breaks in the posterior

skull base The base of skull, also known as the cranial base or the cranial floor, is the most inferior area of the skull. It is composed of the endocranium and the lower parts of the calvaria. Structure Structures found at the base of the skull are for ...

anterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The

temporal bone The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples, and house the structures of the ears. Th ...

fracture is encountered in 75% of all basilar skull fractures and may be longitudinal, transverse or mixed, depending on the course of the fracture line in relation to the longitudinal axis of the

pyramid A pyramid (from el, πυραμίς ') is a structure whose outer surfaces are triangular and converge to a single step at the top, making the shape roughly a pyramid in the geometric sense. The base of a pyramid can be trilateral, quadrilat ...

. Bones may be broken around the

foramen magnum The foramen magnum ( la, great hole) is a large, oval-shaped opening in the occipital bone of the skull. It is one of the several oval or circular openings (foramina) in the base of the skull. The spinal cord, an extension of the medulla oblon ...

, the hole in the base of the skull through which the

brain stem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is conti ...

exits and becomes the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

. This may result in injury to the blood vessels and nerves exiting the foramen magnum. Due to the proximity of the

s, injury to those nerves may occur. This can cause loss of function of the

facial nerve The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of tas ...

oculomotor nerve The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements of ...

, or hearing loss due to damage of

cranial nerve VIII The vestibulocochlear nerve or auditory vestibular nerve, also known as the eighth cranial nerve, cranial nerve VIII, or simply CN VIII, is a cranial nerve that transmits sound and equilibrium (balance) information from the inner ear to the b ...

Management

Evidence does not support the use of preventive

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

s, regardless of the presence of a

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the bra ...

leak.

Prognosis

Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get

meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

. The efficacy of prophylactic antibiotics in these cases is uncertain.

Temporal bone fractures

Acute injury to the internal

carotid artery Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of t ...

( carotid dissection, occlusion,

pseudoaneurysm A pseudoaneurysm, also known as a false aneurysm, is a locally contained hematoma outside an artery or heart due to damage to the vessel wall. The injury goes through all the three layers of the arterial wall causing a leak, which is contained b ...

formation) may be asymptomatic or result in life-threatening bleeding. They are almost exclusively observed when the

carotid canal The carotid canal is a passageway in the temporal bone of the skull through which the internal carotid artery enters the middle cranial fossa from the neck. Structure The carotid canal is located within the middle cranial fossa, at the petrous ...

is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.

Society and culture

Basilar skull fractures are a common cause of death in many

motor racing Motorsport, motorsports or motor sport is a global term used to encompass the group of competitive sporting events which primarily involve the use of motorized vehicles. The terminology can also be used to describe forms of competition of two ...

accidents. Drivers who have died as a result of basilar skull fractures include

Formula One Formula One (also known as Formula 1 or F1) is the highest class of international racing for open-wheel single-seater formula racing cars sanctioned by the Fédération Internationale de l'Automobile (FIA). The World Drivers' Championship, ...

driver

Roland Ratzenberger Roland Ratzenberger (; 4 July 1960 – 30 April 1994) was an Austrian racing driver who raced in various categories of motorsport, including British Formula 3000, Japanese Formula 3000 and Formula One. Having had sporadic success throughout t ...

;

IndyCar INDYCAR, LLC, is an American-based auto racing sanctioning body for Indy car racing and other disciplines of open wheel car racing. The organization sanctions five racing series: the premier IndyCar Series with its centerpiece the Indianapolis ...

drivers

Bill Vukovich William John Vukovich Sr. (; December 13, 1918 – May 30, 1955) was an American automobile racing driver of Serbian descent. He won the 1953 and 1954 Indianapolis 500, plus two more American Automobile Association National Championship races, ...

Sr.,

Tony Bettenhausen Melvin Eugene "Tony" Bettenhausen (September 12, 1916 – May 12, 1961) was an American racing driver, who won the National Championship in 1951 and 1958. Bettenhausen was nicknamed the "Tinley Park Express" in honor of his hometown. He was n ...

Sr., Floyd Roberts, and

Scott Brayton Scott Everts Brayton (February 20, 1959 – May 17, 1996) was an American race car driver on the American open-wheel circuit. He competed in 14 Indianapolis 500s, beginning with the 1981 event. Brayton was killed in practice after qualifying ...

;

NASCAR The National Association for Stock Car Auto Racing, LLC (NASCAR) is an American auto racing sanctioning and operating company that is best known for stock car racing. The privately owned company was founded by Bill France Sr. in 1948, and hi ...

drivers

Dale Earnhardt Sr. Ralph Dale Earnhardt Sr. (; April 29, 1951February 18, 2001) was an American professional stock car driver and team owner, who raced from 1975 to 2001 in the former NASCAR Winston Cup Series (now called the NASCAR Cup Series), most notably driv ...

Adam Petty Adam Kyler Petty (July 10, 1980 – May 12, 2000) was an American professional stock car racing driver. He was the fourth generation from the Petty family to drive in races in the highest division of NASCAR racing, mostly in what was then kno ...

, Tony Roper,

Kenny Irwin Jr. Kenneth Dale Irwin Jr. (August 5, 1969 – July 7, 2000) was an American stock car racing driver. He had driven in all three NASCAR national touring series, and had two total victories, both in the Craftsman Truck Series (today Camping World Tru ...

Neil Bonnett Lawrence Neil Bonnett (July 30, 1946 – February 11, 1994) was an American NASCAR driver who compiled 18 victories and 20 poles over his 18-year career. Bonnett was a member of the Alabama Gang, and started his career with the help of Bobby an ...

John Nemechek John Frank Nemechek (March 12, 1970 – March 21, 1997) was an American racing driver who most notably competed in the NASCAR Craftsman Truck Series. Life and racing career The younger brother of four-time NASCAR Cup Series race winner Joe Neme ...

, J. D. McDuffie, and

Richie Evans Richard Ernest Evans (July 23, 1941Bourcier, Bones, "61 at 61", ''Speedway Illustrated'' (ISSN 1528-4182), Volume 3, Number 8, August 2002. – October 24, 1985), was an American racing driver who won nine NASCAR National Modified Championships, ...

;

CART A cart or dray (Australia and New Zealand) is a vehicle designed for transport, using two wheels and normally pulled by one or a pair of draught animals. A handcart is pulled or pushed by one or more people. It is different from the flatbed tr ...

drivers

Jovy Marcelo Edward Jovy Jacinto Marcelo (April 20, 1965 – May 15, 1992), better known simply as Jovy Marcelo, was a Filipinos, Filipino race car driver from Quezon City, Philippines, who was killed in an accident during practice for the 1992 Indianapolis ...

, Greg Moore, and Gonzalo Rodriguez; and ARCA drivers

Blaise Alexander Blaise Robert Alexander Jr. (March 26, 1976 – October 4, 2001) was an American professional stock car racer from Montoursville, Pennsylvania. He began racing at the age of 12 in go-karts, winning the coveted World Karting Association East Region ...

and

Slick Johnson Julius David "Slick" Johnson III (February 23, 1948 – February 14, 1990) was an American stock car racing driver. A veteran of short track competition in the Carolinas, he competed in the NASCAR Winston Cup Series during the 1980s; his best fi ...

Ernie Irvan Virgil Earnest "Ernie" Irvan (born January 13, 1959), occasionally referred to as Swervin' Irvan, is an American former professional stock car racing driver. A retired NASCAR competitor, he is best remembered for his comeback after a serious head ...

is a survivor of a basilar skull fracture sustained at an accident during practice at the

Michigan International Speedway Michigan International Speedway (MIS) is a moderate-banked D-shaped speedway located off U.S. Highway 12 on more than approximately south of the village of Brooklyn, in the scenic Irish Hills area of southeastern Michigan. The track is ...

in 1994. To prevent basilar skull fractures, many motorsports sanctioning bodies mandate the use of head and neck restraints, such as the

HANS device A HANS device (head and neck support device) is a type of head restraint, a safety device in motorsports. Head restraints are mandatory when competing with most major motorsports sanctioning bodies. They reduce the likelihood of head or neck inj ...

. The HANS device has demonstrated its life-saving abilities multiple times, including

Jeff Gordon Jeffery Michael Gordon (born August 4, 1971) is an American former professional stock car racing driver, who is the Vice Chairman for Hendrick Motorsports. He raced full-time from 1993 to 2015, driving the No. 24 Chevrolet for Hendrick M ...

at the 2006 Pocono 500, Michael McDowell at the

Texas Motor Speedway Texas Motor Speedway is a speedway located in the northernmost portion of the U.S. city of Fort Worth, Texas – the portion located in Denton County, Texas. The reconfigured track measures with banked 20° in turns 1 and 2 and banked 24° ...

in 2008,

Robert Kubica Robert Józef Kubica (; born 7 December 1984) is a Poles, Polish racing driver, racing and rally driver, rally driver. He was the first and, , the only Polish racing driver to compete in Formula One. Between 2006 and 2009 he drove for the BMW in ...

at the

2007 Canadian Grand Prix The 2007 Canadian Grand Prix (formally the Formula 1 Grand Prix du Canada 2007) was a Formula One auto race, motor race held on 10 June 2007 at Circuit Gilles Villeneuve in Montreal, Quebec, Canada. It was the sixth race of the 2007 FIA Formula ...

, and

Elliott Sadler Elliott William Barnes Sadler (born April 30, 1975) is an American former professional stock car racing driver. He last competed part-time in the NASCAR Xfinity Series, driving the No. 10 Chevrolet Camaro for Kaulig Racing. Sadler is one of 36 dr ...

at the 2010 Sunoco Red Cross Pennsylvania 500. Ever since the mandatory implementation of the HANS device, there has not been a single driver crash-related fatality in NASCAR's national divisions.

References

External links

{{DEFAULTSORT:Basilar Skull Fracture Injuries of head Bone fractures Causes of death Wikipedia medicine articles ready to translate