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Basilar skull fracture
 
 
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A basilar skull fracture (or Basal skull fracture) is a fracture
Fracture

A fracture is the separation of an object or material into two, or more, pieces under the action of stress .The word fracture is often applied to bones of living creatures, or to crystals or crystalline materials, such as gemstones or metal....
 of the base of the skull, typically involving the temporal bone
Temporal bone

The temporal bones are situated at the sides and base of the skull.The temporal bone supports that part of the face known as the temple ....
, occipital bone
Occipital bone

The occipital bone, a saucer-shaped membrane bone situated at the back and lower part of the skull, is trapezoid in shape and curved on itself. It is pierced by a large oval aperture, the foramen magnum, through which the cranial cavity communicates with the vertebral canal....
, sphenoid bone
Sphenoid bone

The sphenoid bone is a bone situated at the base of the skull in front of the temporal bone and basilar part of the occipital bone.The sphenoid bone is one of the seven bones that articulate to form the orbit ....
, and/or ethmoid bone
Ethmoid bone

The ethmoid bone is a bone in the skull that separates the nasal cavity from the brain. As such, it is located at the roof of the nose, between the two Orbit s....
.

This type of fracture
Bone fracture

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact force or Stress fracture, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cance...
 is rare, occurring as the only fracture in just 4% of severe head injury patients.

Such fractures can cause tears in the membranes surrounding the brain, or meninges
Meninges

The meninges is the system of Mesotheliums which envelops the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater....
, with resultant leakage of the cerebrospinal fluid
Cerebrospinal fluid

Cerebrospinal fluid , Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain....
 (CSF). The leaking fluid may accumulate in the middle ear space, and dribble out through a perforated eardrum (CSF otorrhea) or into the nasopharynx
Nasopharynx

The nasopharynx is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate; it differs from the Mouth and larynx parts of the pharynx in that its cavity always remains patent ....
 via the eustachian tube
Eustachian tube

The Eustachian tube is a tube that links the pharynx to the middle ear. In adults the Eustachian tube is approximately 35 mm long. It is named after the sixteenth century anatomist Bartolomeo Eustachi....
, causing a salty taste.






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A basilar skull fracture (or Basal skull fracture) is a fracture
Fracture

A fracture is the separation of an object or material into two, or more, pieces under the action of stress .The word fracture is often applied to bones of living creatures, or to crystals or crystalline materials, such as gemstones or metal....
 of the base of the skull, typically involving the temporal bone
Temporal bone

The temporal bones are situated at the sides and base of the skull.The temporal bone supports that part of the face known as the temple ....
, occipital bone
Occipital bone

The occipital bone, a saucer-shaped membrane bone situated at the back and lower part of the skull, is trapezoid in shape and curved on itself. It is pierced by a large oval aperture, the foramen magnum, through which the cranial cavity communicates with the vertebral canal....
, sphenoid bone
Sphenoid bone

The sphenoid bone is a bone situated at the base of the skull in front of the temporal bone and basilar part of the occipital bone.The sphenoid bone is one of the seven bones that articulate to form the orbit ....
, and/or ethmoid bone
Ethmoid bone

The ethmoid bone is a bone in the skull that separates the nasal cavity from the brain. As such, it is located at the roof of the nose, between the two Orbit s....
.

This type of fracture
Bone fracture

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact force or Stress fracture, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cance...
 is rare, occurring as the only fracture in just 4% of severe head injury patients.

Such fractures can cause tears in the membranes surrounding the brain, or meninges
Meninges

The meninges is the system of Mesotheliums which envelops the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater....
, with resultant leakage of the cerebrospinal fluid
Cerebrospinal fluid

Cerebrospinal fluid , Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain....
 (CSF). The leaking fluid may accumulate in the middle ear space, and dribble out through a perforated eardrum (CSF otorrhea) or into the nasopharynx
Nasopharynx

The nasopharynx is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate; it differs from the Mouth and larynx parts of the pharynx in that its cavity always remains patent ....
 via the eustachian tube
Eustachian tube

The Eustachian tube is a tube that links the pharynx to the middle ear. In adults the Eustachian tube is approximately 35 mm long. It is named after the sixteenth century anatomist Bartolomeo Eustachi....
, causing a salty taste. CSF may also drip from the nose (CSF rhinorrhea
Rhinorrhea

Rhinorrhea, commonly known as a runny nose, consists of an unusually significant amount of nasal discharge. It is a symptom of the common cold and of allergies ....
) in fractures of the anterior skull base, yielding a halo sign
Halo sign

In radiology, the halo sign is a finding on ultrasound that suggests the diagnosis of temporal arteritis. The standard diagnostic test for temporal arteritis is biopsy; however, ultrasound and MRI show promise for replacing it....
. These signs are pathognomonic
Pathognomonic

Pathognomonic is an adjective of Greek origin , often used in medicine, which means diagnosis for a particular disease. A pathognomonic Medical sign is a particular sign whose presence means, beyond any doubt, that a particular disease is present....
 for basilar skull fracture.

Anatomy

Basilar skull fractures include breaks in the posterior skull base or anterior 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.

Bones may be broken around the foramen magnum
Foramen magnum

In anatomy, in the occipital bone, the foramen magnum is one of the several oval or circular apertures in the base of the skull , through which the medulla oblongata enters and exits the skull vault....
, the hole in the base of the skull through which the spinal cord
Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
 exits and becomes the brain stem
Brain stem

The brain stem is the lower part of the brain, adjoining and structurally continuous with the spinal cord. The brain stem provides the main motor and sensory innervation to the face and neck via the cranial nerves....
, creating the risk that blood vessels and nerves exiting the hole may be damaged.

Due to the proximity of the cranial nerves, injury to those nerves may occur. This can cause palsy
Palsy

In medicine, palsy is the paralysis of a body part, often accompanied by loss of Somatosensory system and by uncontrolled body movements, such as shaking....
 of the facial nerve
Facial nerve

The facial nerve is the seventh of twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla oblongata, and controls the muscles of facial expression, and taste to the anterior two-thirds of the tongue....
 or oculomotor nerve
Oculomotor nerve

The oculomotor nerve is the third of twelve paired cranial nerves. It controls most of the eye's movements, constriction of the pupil, and maintains an open eyelid....
 or hearing loss due to damage of cranial nerve VIII.

Clinical manifestations

  • Battle's sign
    Battle's sign

    In medical terminology, Battle's sign, also Mastoid process ecchymosis, is an indication of Bone fracture of the base of the posterior portion of the skull and may suggest underlying brain trauma....
     - is ecchymosis
    Ecchymosis

    An ecchymosis is a spot caused by loss of blood from a vessel.It implies a larger size than a petechiae.It has a more diffuse border than purpura....
     of the mastoid process
    Mastoid process

    The mastoid process is a conical prominence projecting from the undersurface of the mastoid portion of the temporal bone. It is located just behind the external acoustic meatus, and lateral to the styloid process ....
     of the temporal bone.
  • Raccoon eyes
    Raccoon eyes

    Raccoon eyes or periorbital ecchymosis is a medical sign of basal skull fracture. It results from blood from skull fracture tracking down into the soft tissue around the eyes....
     - is periorbital ecchymosis
    Ecchymosis

    An ecchymosis is a spot caused by loss of blood from a vessel.It implies a larger size than a petechiae.It has a more diffuse border than purpura....
     i.e. "black eyes"
  • Cerebrospinal fluid
    Cerebrospinal fluid

    Cerebrospinal fluid , Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain....
     rhinorrhea
    Rhinorrhea

    Rhinorrhea, commonly known as a runny nose, consists of an unusually significant amount of nasal discharge. It is a symptom of the common cold and of allergies ....
  • Cranial nerve palsy
    Palsy

    In medicine, palsy is the paralysis of a body part, often accompanied by loss of Somatosensory system and by uncontrolled body movements, such as shaking....
  • Bleeding from the nose and ears
  • Hemotympanum
    Hemotympanum

    Hemotympanum, or hematotympanum, refers to the presence of blood in the tympanic cavity of the middle ear. Hemotympanum is often the result of basilar skull fracture....
  • In 1 to 10% of patients, ocular nerve entrapment occurs: the ocular nerve is pressed by the broken skull bones, causing irregularities in vision.
  • Death
    Death

    Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....


Prognosis

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

Meningitis is a medical condition caused by inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges....
.

Vascular Complications of Temporal Bone Fractures

Acute injury to the internal carotid artery (carotid dissection, occlusion, pseudoaneurysm
Pseudoaneurysm

A pseudoaneurysm, also known as a false aneurysm, is the result of trauma to all three layers of an artery resulting in a hematoma that contains the blood....
 formation) may be asymptomatic or result in life-threatening hemorrhage. They are almost exclusively observed when the carotid canal
Carotid canal

On the interior surface of the temporal bone, behind the rough surface of the apex, is the large circular aperture of the carotid canal, which ascends at first vertically, and then, making a bend, runs horizontally forward and medialward....
 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.

Association With Auto Racing

Basilar skull fracture is a common cause of death in auto racing accidents:
  • Formula 1 driver Roland Ratzenberger
    Roland Ratzenberger

    Roland Ratzenberger was an Austrian racing driver who died during qualifying for the 1994 San Marino Grand Prix, the same event that saw Death of Ayrton Senna of three-time Formula One list of Formula One World Drivers' Champions Ayrton Senna....
     in the 1994 San Marino Formula One Grand Prix
    1994 San Marino Grand Prix

    The 1994 San Marino Grand Prix was a Formula One motor race held on May 1, 1994 at the Autodromo Enzo e Dino Ferrari in Imola, Italy. It was the third race of the 1994 Formula One season, and the first race of the season to be held in Europe....
  • Indy 500 drivers Bill Vukovich
    Bill Vukovich

    Bill Vukovich was an United States of America motorsport racing driver. He was known variously as "Vuky" and "The Mad Russian" for his intense driving style, as well as the "Silent Serb" for his cool demeanor....
    , Tony Bettenhausen
    Tony Bettenhausen

    Melvin E. "Tony" Bettenhausen was an American racing driver, who won the American Championship Car Racing in 1951 and 1958.Bettenhausen was nicknamed the "Tinley Park Express" in honor of his hometown....
     and Floyd Roberts
    Floyd Roberts

    Floyd Roberts is a former Championship Car racing driver from Jamestown, North Dakota. He won the Indianapolis 500 in 1938 with a record speed of ....
    .
  • NASCAR
    NASCAR

    The National Association for Stock Car Auto Racing is the largest sanctioning body of stock cars in the United States. The three largest racing series sanctioned by NASCAR are the Sprint Cup Series, the Nationwide Series and the Camping World Truck Series....
     drivers Dale Earnhardt
    Dale Earnhardt

    Ralph Dale Earnhardt, Sr. was an American race car driver, best known for his career driving stock cars in NASCAR's Winston Cup. Earnhardt had four children, Kerry Earnhardt, Kelley Earnhardt Elledge, Dale Earnhardt, Jr., and Taylor Earnhardt....
    , Adam Petty
    Adam Petty

    Adam Kyler Petty was an auto racing car driver. He was the first fourth-generation driver in NASCAR history....
    , Tony Roper
    Tony Roper

    Tony Roper was a NASCAR driver. He was born in Springfield, Missouri, to Dean Roper and Shirley Medley. Growing up his family was heavily involved in auto racing....
    , Kenny Irwin, Jr.
    Kenny Irwin, Jr.

    Kenneth Dale Irwin, Jr. was a NASCAR stock car driver. He had driven in all three major of forms of NASCAR and had two total victories. Before that, he raced in the United States Auto Club against Tony Stewart who was one of his fiercest rivals....
    , Neil Bonnett
    Neil Bonnett

    Lawrence Neil Bonnett was a NASCAR driver who compiled 18 victories and 20 Pole Position over his 18-year career. The Hueytown, Alabama native currently ranks 35th in all time NASCAR Cup wins....
    , John Nemechek
    John Nemechek

    John Nemechek , was a race car driver who was killed in an accident during a Craftsman truck race at Homestead, Florida....
    , J. D. McDuffie, Blaise Alexander
    Blaise Alexander

    Blaise Alexander , was a stock car racer from Montoursville, Pennsylvania. He began racing at the age of 12 in go-karts, winning the coveted World Karting Association East Regional championship in 1992....
    , Richie Evans
    Richie Evans

    Richard Ernest Evans , was an American racing driver who won nine NASCAR National Modified Championships, including eight in a row from 1978 to 1985....
    , and Clifford Allison. Stanley Smith
    Stanley Smith

    Stanley Smith is a retired NASCAR driver and dirt-track racer.At the 1993_in_NASCAR#Diehard_500 at Talladega Superspeedway, Smith nearly died from a basilar skull fracture in a massive crash -- the same type of injury that later killed Dale Earnhardt....
     also suffered the injury, but recovered.
  • CART
    Cart

    A cart is a vehicle or device designed for transport, using two or four wheels and normally pulled by one or a pair of draught animals. A handcart is pulled or pushed by one or more people....
     drivers Jovy Marcelo
    Jovy Marcelo

    Edward Jovy Marcelo was a Filipino people race car driver from Quezon City, Philippines who was killed in Practice for the 1992 Indianapolis 500....
    , Greg Moore
    Greg Moore (race car driver)

    Greg Moore was a Canada racecar driver who competed in the Indy Lights and CART World Series, where he had great success with several wins in both series and a championship in the 1995 Indy Lights series....
     and Gonzalo Rodriguez
    Gonzalo Rodriguez

    Gonzalo Gonchi Rodr?guez was a racing driver. He showed promise in International Formula 3000 for three seasons, taking two wins in 1998 Formula 3000 season at Circuit de Spa-Francorchamps and N?rburgring, winning the 1999 Formula 3000 season in Circuit de Monaco and finishing third in both championships....
  • ARCA
    ARCA

    ARCA or Arca may refer to:* A Latin word for a Chest used to store valuables* Automobile Racing Club of America, a stock car auto racing sanctioning body in the United States founded in 1952...
     driver Blaise Alexander
    Blaise Alexander

    Blaise Alexander , was a stock car racer from Montoursville, Pennsylvania. He began racing at the age of 12 in go-karts, winning the coveted World Karting Association East Regional championship in 1992....


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

The HANS device aka Head restaint is a safety item compulsory in many car racing sports. It reduces the chances of head and/or neck injuries, such as a basilar skull fracture, in the event of a crash....
.

See also

  • Temporal bone
    Temporal bone

    The temporal bones are situated at the sides and base of the skull.The temporal bone supports that part of the face known as the temple ....
  • Skull fracture
    Skull fracture

    A skull fracture is a break in one or more of the bones in the skull caused by a head injury. Isolated skull fractures are not very serious injuries, but the presence of a skull fracture may indicate that significant enough impact occurred to cause brain trauma, which is quite serious....
  • Bone fracture
    Bone fracture

    A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact force or Stress fracture, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cance...


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