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Hi, I'm Ciléin Kearns, a Doctor & Medical Illustrator drawing from a background in Concept Art, and Medicine/Surgery.

Base of skull fracture

Base of skull fracture

Base of skull fracture caretoon by Dr Ciléin Kearns
Base of skull fracture caretoon by Dr Ciléin Kearns

Base of skull fractures can produce the clinical signs seen in my caretoon:

  1. ‘Raccoon eyes’ AKA periorbital bruising
    This is bruising around the eyes, sometimes seen with tarsal plate sparing; this is where the bruising doesn’t cover the upper eyelid, which contains the ‘tarsal plate’, a small area of connective tissue which helps stop the eyelid inverting when opening and closing the eye.
  2. Blood or CSF rhinorrhoea (nose leakage) and otorrhoea (ear leakage)
    These fluids may leak from the nose or ear. CSF is cerebrospinal fluid; the clear fluid which surrounds the brain and spinal cord.
  3. Haemotympanum
    This is blood seen behind the eardrum (AKA tympanic membrane) when using an otoscope, the tool a doctor uses to look inside the ear canal.
  4. ‘Battle sign’ AKA postauricular bruising
    Bruising may appear behind the ear.

These clinical signs occur in base of skull fractures, when the cracked bone, or trauma that caused it, results in damage to the blood vessels or/and brains covering, allowing leakage of their contents into these areas of the head and neck.

They make up a classic set of signs emergency doctors will look for when assessing patients who have had a head injury. They can be a marker of how severe the trauma has been, and alert medics to consider further imaging (scans) to go looking for further damage or compromise to structures within the skull.

These signs are important ‘free information’ to pick up if you have a sharp eye!


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