Surgical Pathology
- Fracture through base of skull from severe trauma results in blood or CSF tracking externally
- Diagnosis best confirmed on CT scan. Indirect evidence is fluid in ethmoid or mastoid air cells
- By inference dural break has occurred and potential risk of infection > meningitis
Clinical features
- Anterior cranial fossa – bilateral periorbital haematoma (‘racoon eyes’), CSF rhinorrhea
- Middle cranial fossa – mastoid haematoma (‘Battle’s sign), CSF otorrhea, haemotympanum
Management
- Nothing may be required in isolation
- Dural repair may be attempted in cases of recurrent infection
- Presence of increases likelihood of associated intracranial bleeding which may required treatment
Controversies
- Prophylactic antibiotics have no proven benefit in preventing infection