A basilar skull fracture may be difficult to recognize on a skull X-ray due to the complexity of bones in that region. Often the first clue to the fracture will be a clinical finding on physical examination.


Clinical findings associated with basilar skull fracture:

(1) nasal hemorrhage

(2) blood around the eyes ("raccoon's eyes")

(3) blood in the middle ear

(4) bleeding from the external auditory canal

(5) bleeding over the mastoid process, behind the ears (Battle's sign)

(6) cranial nerve palsies (especially CN VII and VIII)

(7) leakage of CSF from the nose (cerebrospinal rhinorrhea)

(8) leakage of CSF from the ear (cerebrospinal otorrhea)

(9) irregular respirations, unexplained hypotension, tachycardia (with occipital fractures involving the foramen magnum)


Radiographic findings:

(1) hemorrhage into the maxillary sinuses (may be confused with sinusitis)

(2) intracranial air


A CT scan can be helpful in identifying the location of the fracture.


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