Peripheral hearing loss following head trauma in children. Traumatic perilymphatic fistulas in children: etiology, diagnosis andmanagement. Int J Pediatr Otorhinolaryngol. Management of complications from temporal bone fractures. Am J Otol. Otic barotrauma from air travel. Basic Imaging of Skull Base Trauma. Otolaryngol Neck Surg. Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome.
Nosocomial bacterial meningitis. N Engl J Med. Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg. Gautschi OP, Zellweger R. Asymptomatic posttraumatic pneumocephalus. Am J Emerg Med. Images in anesthesiology: pneumocephalus resulting from basilarskull fracture. Maradi N, M SB. Hearing loss following temporal bone fractures- a study on classificationof fractures and the prognosis.
Martinez L. Basilar Skull FracturesDecember Grand Rounds presentation presented at the: Posttraumatic anosmia in craniofacial trauma.
J Cranio-Maxillofac Trauma. Predicting recovery of facial nerve function following injury from a basilar skull fracture.
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Accessed March 10, The significance of carotid canal involvement in basilarcranial fracture. Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria.
J Neurosci Rural Pract. Radiol Med Torino. The clinical correlation of temporal bone fractures and spiral computed tomographic scan: a prospective and consecutive study at a level I trauma center. The value of computed tomographic scans in patients with low-risk head injuries. The contribution of high-resolution multiplanar reformats of the skull base to the detection of skull-base fractures. Clin Radiol. Pediatric basilar skull fracture: do children with normal neurologic findings and no intracranial injury require hospitalization?
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Accessed March 18, Skull base, orbits, temporal bone, and cranial nerves: anatomy on MR imaging. Tuntiyatorn L, Laothammatas J. Evaluation of MR cisternography in diagnosisof cerebrospinal fluid fistula. Diagram 2. Top Stories.
Getting the data on homelessness. Hospital News. MRT Week has started: Let's celebrate and recognize this essential role in health care.
Ensuring patients and Essential Care Partners are heard in palliative care. Donor Impact. Miracle Treat Day is Thursday October 28! Diagram 2 Diagram 1. How are basal skull fractures diagnosed? Basal skull fractures are often not detectable with skull x-rays or even CT scan.
Basal skull fractures are most frequently diagnosed by clinical findings, making clinical assessment skills critical. CT may reveal suspicious fluid collections near a fracture if bleeding has occurred, or if damage to the dura resulted in a leak of CSF. Prior to the advent of high-resolution CT HRCT scanners, the diagnosis of temporal bone fractures was predominantly clinical. Recent studies have shown that maxillofacial CT and HRCT of the temporal bone are comparable and most suited for the diagnosis of temporal bone fracture.
All patients with basilar skull fractures should be admitted for observation. Management is based on anticipated complications.
Most post-traumatic CSF leaks heal with a conservative management of bed rest and head elevation. The use of prophylactic antibiotics for meningitis is one area of controversy. A large meta-analysis of patients showed no statistically significant decrease in the incidence of meningitis in patients who were given antibiotics.
Therefore, in such cases, antibiotics may be indicated. Maintaining a high index of suspicion for the presence of an epidural hematoma is essential, even if this is not seen on initial imaging studies. Any associated intracranial hemorrhage warrants prompt neurosurgical consultation. Traumatic facial nerve palsy is another well-known complication of basilar skull fractures.
It generally presents two to three days after the injury and should be managed in consultation with an otolaryngologist; glucocorticoids may be beneficial. Central skull base fractures, frequently involving the sphenoid sinus and temporal bone, are associated with vascular complications. The internal carotid and basilar arteries are particularly vulnerable due to their course through the central skull base and cavernous sinus. As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion.
The jarring of the brain against the sides of the skull can cause shearing tearing of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.
The person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head injury.
However, each individual may experience symptoms differently. Symptoms may include:. Moderate to severe head injury requires immediate medical attention --symptoms may include any of the above plus:.
Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event. One pupil dark area in the center of the eye is dilated, or looks larger, than the other eye and doesn't constrict, or get smaller, when exposed to light. Coma a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities.
Vegetative state a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation.
Locked-in syndrome a neurological condition in which a person is conscious and can think and reason, but cannot speak or move. The symptoms of a head injury may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.
The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.
A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images often called slices of the body.
A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Electroencephalogram EEG. A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. Magnetic resonance imaging MRI.
A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Moderate sedation or assistance with breathing that would require being placed on a breathing machine, or mechanical ventilator or respirator.
Treatment is individualized, depending on the extent of the condition and the presence of other injuries. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure pressure inside the skull. Head injury may cause the brain to swell.
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