Basilar skull fracture
2593857
224812465
2008-07-10T15:04:19Z
SWik78
1532110
/* Notable cases */ directing link to proper article
{{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 base of the [[skull]]. This type of [[bone fracture|fracture]] is rare, occurring as the only fracture in just 4% of severe head injury patients.<ref name="Graham and Gennareli">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. </ref><ref name="Orlando Regional">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]].</ref> Moreover, it is most often associated with leakage in the cerebrospinal fluid of the brain into the ear (CSF [[otorrhea]]) or the nose (CSF [[rhinorrhea]]). These signs are [[pathognomonic]] for basilar skull fracture.<ref name="singh">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on [[January 26]], [[2007]].</ref>
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 [[skull suture|suture]] between the [[occipital bone|occipital]] and [[temporal bone]]s.
==Anatomy==
Basilar skull fractures commonly involve the roof of the [[orbit (eye)|orbit]]s, 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.<ref name="BAIUSA">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]].</ref>
Due to the proximity of the [[cranial nerve]]s, injury to those nerves may occur.<ref name="singh"/> This can cause [[palsy]] of the [[facial nerve]] or [[oculomotor nerve]] or hearing loss due to damage of [[cranial nerve VIII]].<ref name="singh"/>
==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
*In 1 to 10% of patients, [[ocular nerve]] entrapment occurs:<ref name="singh"/> 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]].<ref name="Dagi ">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]].</ref>
==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 Grand Prix|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 (race car driver)|Greg Moore]] and [[Gonzalo Rodriguez]]
* [[ARCA]] driver [[Blaise Alexander]]
Other drivers survived their Basilar skull fractures, including NASCAR's [[Ernie Irvan]].
To prevent this injury, all major motor sports sanctioning bodies now mandate the use of head and neck restraints, such as the [[HANS device|HANS Device]].
==See also==
* [[Skull fracture]]
* [[Bone fracture]]
==References==
<references />
==External links==
* {{GPnotebook|-2093678563}}
{{Surgery-stub}}
{{Fractures}}
[[Category:Bone fractures]]
[[da:Basisfraktur]]
[[de:Schädelbasisbruch]]
[[nl:Schedelbasisfractuur]]