Seal of Good Local Governance (SGLG) 2024Final.pptx
Basilar Skull Fracture
1.
2. 33 YOF brought in by
EMS after attending a
high school baseball
game, and being struck
behind the right ear by a
flying baseball bat while
sitting in the stands. She
c/o pain behind R ear,
tinnitus, dizziness, and
slurred speech. Denies
LOC, N/V.
AFVSS
Gen: WDWN, A&Ox4
HEENT: NC/AT, PERRL,
EOMi, nml bilat visual
acuity, bilat TMs intact,
right hemotympanum,
right facial motor
weakness, TTP right
mastoid w/o
retroauricular ecchymosis
Neuro: GCS-14 (Eyes 3),
nml sensation x 4, 5/5
motor strength x 4
3.
4. 1. Air in Internal Auditory
Canal (thin arrow).
2. Transverse temporal bone
fracture (thick arrow).
3. Normal suture line
between temporal and
occipital bones.
5. Non contrast CT head:
necessary for suspected basilar skull fx.
r/o TBI, intracranial bleeds
+/- Prophylactic antibiotics for CSF rhinorrhea/otorrhea:
should be done in consultation with Neurosurgery/ENT as
most CSF leaks will resolve spontaneously in one week w/o
complications
if patient presents 1 wk s/p CSF leak with fever, Abx are
warranted, along with meningitis work-up (LP included)
Broad coverage Abx w good penetration into meninges, eg.
Ceftriaxone, Vancomycin IV
Tetanus prophylaxis
Neurosurgery/Otolaryngology consultation
7. Most basilar skull fractures (BSF) involve petrous portion
of temporal bone, external auditory canal and TM, but may
occur anywhere from cribriform plate to occipital condyle.
Torn dura leads to otorrhea/rhinorrhea
May be only sign of basilar skull fracture
Perform and document thorough HEENT exam
BSF may be subtle on CT scan
Look for air/fluid levels in sinuses; pneumocephalus suggests
open fx
Periorbital and mastoid ecchymoses develop slowly (up to
12-24 hours s/p injury), and often absent in ED.
