Basilar skull fracture

DiseaseDisorder infobox
Name = Basilar skull fracture
ICD10 = ICD10|S|02|1|s|00
ICD9 = ICD9|801.1
A basilar skull fracture (or Basal skull fracture) is a linear skull fracture involving the basilar bone of the skull. The occipital bone forms the floor of the skull, where the brain is held.

This type of fracture is rare, occurring as the only fracture in just 4% of severe head injury patients.Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York. ] Orlando Regional Healthcare, Education and Development. 2004. [http://www.orlandoregional.org/pdf%20folder/overview%20adult%20brain%20injury.pdf "Overview of Adult Traumatic Brain Injuries."] Retrieved on January 16, 2008.]

Such fractures can cause tears in the sack compartments that hold the brain, with resultant leakage of the cerebral spinal fluid (CSF) into the ear (CSF otorrhea) or the nose (CSF rhinorrhea). These signs are pathognomonic for basilar skull fracture.Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on January 26, 2007.]

Basilar skull fractures can be caused by a blow to the back of the head, or by sudden deceleration of torso but not head (as in traffic accidents), resulting in separation of the suture between the occipital and temporal bones.

Anatomy

Basilar skull fractures commonly involve the roof of the orbits, the sphenoid bone, or portions of the temporal bone.

Bones may be broken around the foramen magnum, the hole in the base of the skull through which the spinal cord enters and becomes the brain stem, creating the risk that blood vessels and nerves exiting the hole may be damaged.Brain Injury Association of America (BIAUSA). [http://www.biausa.org/Pages/types_of_brain_injury.html#diffuse "Types of Brain Injury."] Retrieved on January 26, 2007.]

Due to the proximity of the cranial nerves, injury to those nerves may occur. This can cause palsy of the facial nerve or oculomotor nerve or hearing loss due to damage of cranial nerve VIII.

Clinical manifestations

*Battle's sign - is ecchymosis of the mastoid process of the temporal bone.
*Raccoon eyes - is periorbital ecchymosis i.e. "black eyes"
*Cerebrospinal fluid rhinorrhea
*Cranial nerve palsy
*Bleeding from the nose and ears
* Hemotympanum
*In 1 to 10% of patients, ocular nerve entrapment occurs: the ocular nerve is pressed by the broken skull bones, causing irregularities in vision.

Prognosis

Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get meningitis.Dagi TF, Meyer FB, and Poletti CA. 1983. The incidence and prevention of meningitis after basilar skull fracture. "American Journal of Emergency Medicine". Volume 1, Issue 3, Pages 295-298. PMID 6680635. Retrieved on March 16, 2007.]

Notable cases

Basilar skull fracture is a common cause of death in auto racing accidents:
* Formula 1 driver Roland Ratzenberger in the 1994 San Marino Formula One Grand Prix
* Indy 500 drivers Bill Vukovich, Tony Bettenhausen and Floyd Roberts.
* NASCAR drivers Dale Earnhardt, Adam Petty, Tony Roper, Kenny Irwin, Neil Bonnett, John Nemechek, J. D. McDuffie and Clifford Allison
* CART drivers Jovy Marcelo, Greg Moore and Gonzalo Rodriguez
* ARCA driver Blaise Alexander

Other drivers survived their Basilar skull fractures.

To prevent this injury, all major motor sports sanctioning bodies now mandate the use of head and neck restraints, such as the HANS Device.

ee also

* Skull fracture
* Bone fracture

References

External links

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