basal skull fracture
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Clinical features may suggest a basal skull fracture even in the absence of a positive skull x-ray.

Evidence of anterior fossa fracture:

  • CSF rhinorrhoea:
    • due to damage to the cribriform plate
    • this often requires formal dural repair

  • bilateral periorbital haematoma:
    • bruising limited to the orbital margins indicates blood tracking from behind

  • subconjunctival haemorrhage where the posterior margin cannot be seen

Evidence of petrous temporal fracture:

  • bleeding from the external auditory meatus

  • CSF otorrhoea:
    • through a torn tympanic membrane
    • usually a linear injury which does not require formal dural repair

  • Battle's sign:
    • bruising over the mastoid
    • may take 24-48 hr to develop

A basal skull fracture provides a route for infection. Antibiotics are given to prevent meningitis; the course lasts at least seven days, or if there is a CSF leak, until seven days after this has ceased.

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