Skull Fractures Overview
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Questions and Answers

Closed linear fractures of the skull vault are managed how?

  • Debridement and prophylactic antibiotic therapy
  • Conservatively (correct)
  • Observation
  • Surgery

Open or comminuted fractures of the skull vault should be managed with what?

  • Conservatively
  • Surgery
  • Debridement and prophylactic antibiotic therapy (correct)
  • Observation

Skull base fractures are relatively infrequent.

False (B)

Skull base fractures are often occult radiologically.

<p>True (A)</p> Signup and view all the answers

How are skull base fractures often diagnosed?

<p>Clinical Examination (C)</p> Signup and view all the answers

Skull base fractures can result in a CSF fistula.

<p>True (A)</p> Signup and view all the answers

Which of these are types of skull base fractures?

<p>All of the Above (D)</p> Signup and view all the answers

What is the name of the structure that separates the anterior fossa from the nasal cavity?

<p>Cribriform Plate</p> Signup and view all the answers

Which of these is a clinical presentation of an anterior fossa basal fracture?

<p>All of the Above (G)</p> Signup and view all the answers

Blind nasogastric tube placement is contraindicated in patients with anterior fossa basal fractures.

<p>True (A)</p> Signup and view all the answers

What makes up the middle fossa?

<p>Petrous Temporal Bone (D)</p> Signup and view all the answers

Which of these is a clinical presentation of a middle fossa basal fracture?

<p>All of the Above (E)</p> Signup and view all the answers

What is the name of the sign that refers to discoloration over the mastoid process?

<p>Battle sign (B)</p> Signup and view all the answers

Posterior fossa basal fractures involve the suboccipital region.

<p>True (A)</p> Signup and view all the answers

Which cranial nerves are typically involved in posterior fossa basal fractures?

<p>9th, 10th, and 11th cranial nerves (B)</p> Signup and view all the answers

What is the immediate management of a skull base fracture?

<p>All of the Above (D)</p> Signup and view all the answers

What are the primary goals of treating a skull base fracture?

<p>All of the Above (D)</p> Signup and view all the answers

What are the indications for surgery in managing a skull base fracture with CSF rhinorrhea?

<p>All of the above (D)</p> Signup and view all the answers

Define Extradural hematoma.

<p>An extradural hematoma is a neurosurgical emergency that occurs due to the rupture of an artery, vein, or venous sinus within the skull, usually associated with a skull fracture.</p> Signup and view all the answers

Extradural hematoma always leads to immediate unconsciousness.

<p>False (B)</p> Signup and view all the answers

Which of these is a cardinal sign of brain compression and herniation caused by an extradural hematoma?

<p>All of the Above (D)</p> Signup and view all the answers

The 'talk and die' pattern of deterioration in extradural hematoma is always evident.

<p>False (B)</p> Signup and view all the answers

What is the preferred management for an acute subdural hematoma?

<p>Craniotomy or Craniectomy (C)</p> Signup and view all the answers

What is the common cause of chronic subdural hematoma?

<p>All of the above (D)</p> Signup and view all the answers

Burr-hole drainage is the preferred management for a chronic subdural hematoma.

<p>True (A)</p> Signup and view all the answers

The most common cause of subarachnoid hemorrhage is trauma.

<p>True (A)</p> Signup and view all the answers

Traumatic subarachnoid hemorrhage is usually managed surgically.

<p>False (B)</p> Signup and view all the answers

Traumatic subarachnoid hemorrhage is commonly associated with significant vasospasm, which is also seen in aneurysmal subarachnoid hemorrhage.

<p>False (B)</p> Signup and view all the answers

Cerebral contusions are found predominantly in which regions of the brain?

<p>A and B (C)</p> Signup and view all the answers

What does 'coup contre coup' in cerebral contusions refer to?

<p>'Coup contre-coup' contusions refer to brain injury that happens at both the point of impact and the opposite or ‘countercoup’ point of the brain, due to the acceleration-deceleration forces experienced by the brain inside the skull.</p> Signup and view all the answers

Diffuse axonal injury is a form of secondary brain injury.

<p>False (B)</p> Signup and view all the answers

Diffuse axonal injury is often seen in patients with good outcomes.

<p>False (B)</p> Signup and view all the answers

Which of these are potential signs of diffuse axonal injury on a CT scan?

<p>All of the above (D)</p> Signup and view all the answers

Control of intracranial pressure is important because raised intracranial pressure can lead to secondary brain injury.

<p>True (A)</p> Signup and view all the answers

Which of these measures can help control intracranial pressure?

<p>All of the Above (E)</p> Signup and view all the answers

Which of these medical management strategies is considered first-line for ICP control?

<p>B and C (F)</p> Signup and view all the answers

Post-concussive syndrome is a medical emergency.

<p>False (B)</p> Signup and view all the answers

Which of these are somatic features that can occur in post-concussive syndrome?

<p>All of the Above (D)</p> Signup and view all the answers

Which of these are neurocognitive and neuropsychological disturbances that can occur in post-concussive syndrome?

<p>All of the above (F)</p> Signup and view all the answers

Flashcards

Closed linear skull vault fracture

A fracture of the skull that does not involve the underlying brain tissue and remains closed.

Open skull vault fracture

A fracture of the skull that exposes the brain tissue to the external environment.

Comminuted skull vault fracture

A fracture of the skull that involves multiple bone fragments.

Skull base fracture

A fracture of the base of the skull, often occurring at the junction of the skull with the face.

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Anterior fossa basal fracture

A type of skull base fracture that occurs in the front of the skull, involving the frontal or ethmoidal sinuses or the cribriform plate.

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Subconjunctival hematoma

A collection of blood in the space between the eyelid and the eye.

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Epistaxis

Bleeding from the nose.

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Anosmia

Loss of the sense of smell.

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CSF Rhinorrhea

Leakage of cerebrospinal fluid from the nose.

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Nasal tip paresthesia

A sensation of numbness or tingling around the eye.

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Middle fossa basal fracture

A type of skull base fracture that occurs in the middle of the skull, involving the temporal bone.

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CSF Otorrhoea

Leakage of cerebrospinal fluid from the ear.

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Haemotympanum

Blood in the middle ear, causing a reddish discoloration.

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Battle sign

A bluish discoloration behind the ear, indicating a skull fracture.

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Posterior fossa basal fracture

A type of skull base fracture that occurs in the back of the skull, involving the occipital bone.

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Boggy swelling at the neck

A swelling of the soft tissues at the back of the head.

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Discoloration at the neck

Discoloration in the upper part of the neck.

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Extradural hematoma

A blood clot that forms between the skull and the dura mater, a tough membrane surrounding the brain.

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Intracerebral hemorrhage

A bleed that occurs within the brain itself.

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Subdural hematoma

A collection of blood that forms between the dura mater and the arachnoid mater, two membranes that surround the brain.

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Acute subdural hematoma

A blood clot that forms acutely after an injury.

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Chronic subdural hematoma

A blood clot that forms gradually, sometimes weeks after a traumatic event.

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Subarachnoid hemorrhage

Bleeding into the space surrounding the brain, often caused by a trauma or a ruptured aneurysm.

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Cerebral contusions

Damage to the brain tissue caused by a direct impact.

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Coup contre-coup contusions

Damage to the brain tissue occurring both at the site of impact and the opposite side of the brain.

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Diffuse axonal injury

A type of primary brain injury caused by a strong shaking force.

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Post concussive syndrome

A group of symptoms that occur after a concussion, persisting for a longer period.

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Intracranial pressure (ICP)

Increased pressure within the skull.

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Study Notes

Skull Fractures

  • Closed linear skull fractures are treated conservatively.
  • Open or comminuted fractures require debridement and prophylactic antibiotic therapy.

Skull Base Fractures

  • These fractures are relatively common.
  • They are often occult (not visible on X-rays).
  • Diagnosis is typically made through clinical examination.
  • Fractures may result in CSF fistulas, which usually resolve within a few days.
  • Types of fractures include:
    • Anterior fossa
    • Middle fossa
    • Posterior fossa

Anterior Fossa Fractures

  • May extend into the frontal or ethmoidal sinuses, or across the cribriform plate.
  • Clinical signs can include:
    • Subconjunctival hematoma
    • Epistaxis
    • Anosmia (loss of smell) due to olfactory nerve injury
    • CSF rhinorrhea
    • Nasal tip paresthesia (numbness) due to injury to the first branch of the fifth cranial nerve
    • Periorbital hematoma ("raccoon eyes")
  • Avoid blind nasogastric tube placement in these patients.

Middle Fossa Fractures

  • Involve the petrous temporal bone.
  • Clinical signs can include:
    • CSF otorrhea
    • Hemotympanum
    • Battle sign (discoloration over the mastoid process)
    • VIIth and VIIIth cranial nerve palsies

Posterior Fossa Fractures

  • Often present with a boggy swelling or discoloration at the neck, due to extravasation of blood in the suboccipital region.
  • Can cause injury to cranial nerves IX, X, and XI, especially at the jugular foramen.
  • May also cause retraction of the head and stiffness of the cervical muscles (due to upper cervical nerve irritation)

Management of Skull Base Fractures

  • Prophylactic antibiotics to prevent infection.
  • Management of CSF leaks (may need surgery).
  • Treat associated brain injuries.

Indications for Skull Base Repair

  • Persistent rhinorrhea (runny nose) lasting more than 10 days
  • Fracture involving the frontal or ethmoidal sinuses
  • Meningitis

Extradural Hematoma

  • Neurosurgical emergency
  • Caused by rupture of an artery (middle meningeal artery), vein, or venous sinus, often associated with a skull fracture
  • Often presents with transient loss of consciousness, followed by a lucid interval, and then headache and potentially increased neurological deficits
  • Contralateral hemiparesis, reduced conscious level, and ipsilateral pupillary dilation can suggest brain compression and herniation.

Acute Subdural Hematoma

  • Usually occurs in high-energy injuries or in elderly/anticoagulated patients
  • Often requires urgent evacuation via craniotomy or craniectomy.

Chronic Subdural Hematoma

  • Common in elderly patients on anticoagulants
  • Presents with clinical deficits resulting from clot expansion over days or weeks.
  • Diffuse hypodense lesion on CT.
  • Burr hole drainage is a common treatment.

Traumatic Subarachnoid Hemorrhage

  • Trauma is the most common cause.
  • Typically managed conservatively.
  • Less likely to be associated with vasospasm compared to aneurysmal causes.

Cerebral Contusions

  • Common, occurring where the brain contacts the irregular inner surface of the skull (inferior frontal lobes and temporal poles).
  • "Coup contre-coup" contusions are injuries both at the impact site and on the opposite side of the brain due to acceleration/deceleration forces.

Diffuse Axonal Injury

  • Form of primary brain injury in high-energy accidents.
  • Often results in coma and poor outcomes.
  • Diagnosis is typically made post-mortem.
  • Haemorrhagic foci in the corpus callosum or dorsolateral rostral brainstem on CT scan might suggest this condition.

Control of Intracranial Pressure (ICP)

  • Raised ICP is often due to brain swelling and mass lesions.
  • Management involves raising the head of the bed, loosening neck collars, and controlling seizures and fever.
  • Medical management includes escalating doses of sedatives, analgesics, and potentially muscle relaxants.

Post-Concussive Syndrome

  • Loosely defined collection of symptoms persisting for a prolonged period after injury.
  • Symptoms may include headache, dizziness, hearing/vision disorders, neurocognitive and neuropsychological problems (difficulty concentrating, recall, insomnia, emotional lability, fatigue, depression, personality changes).

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Description

This quiz covers essential information on skull fractures, including the differences between closed and open fractures, treatment protocols, and specific types of skull base fractures. Test your knowledge on clinical signs associated with anterior fossa fractures and related complications.

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