sweetybokhari
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Following a car accident,a patient presents with a clear fluid leaking from his ear and bruising the mastoid region(Battle's sign).which one of the following injuries is most likely?
1) foramen magnum fracture
2) fracture of the supraorbital ridge
3) middle cranial fossa fracture
4) linear fracture of the vault of skull
5) ethmoid bone fracture
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| new_n_lost
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Battle's Sign=Postauricular ecchymosis= Head and Neck: fracture of the base of the of the skull, also seen in temporal bone fractures.
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| keepgoing
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4 or 1
Edited by keepgoing on 03/10/07 - 11:22 AM
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| new_n_lost
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3. Middle Cranial Fossa Fracture ( Not Sure )
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| new_n_lost
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look here is wht i have dug up on this topic
The most common temporal bone fracture occurring from blunt trauma is the longitudinal fracture (80%). Directly applied lateral forces travel through the path of least resistance along the petrosquamous suture line and continues anterior to the otic capsule. This path usually involves major foramina in the skull base. The most common being the carotid artery and jugular bulb. The anterior extension may also include the temporomandibular joint. The most frequent structures involved are the tympanic membrane, the roof of the middle ear, and the anterior portion of the petrous apex. 15-20% will have involvement of the facial nerve, and injury occurs near the geniculate ganglion or in the horizontal portion. The facial paralysis is often delayed in onset, attributed to edema rather than direct interruption of the nerve. [/left]
Temporal bone fractures account for the most common cause of CSF otorrhea. TM or external canal lacerations associated with longitudinal temporal bone fractures will allow CSF otorrhea, whereas in transverse fractures, the CSF may build behind an intact TM and eventually drain via the Eustachian tube.
So i think shud it be Foramina Magum ??
Keepgoing wht r ur thoughts on this topic.
Edited by new_n_lost on 03/10/07 - 11:39 AM
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| new_n_lost
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Nope found the Answer easily written in KLM 6th edition pg 925 n 4th e. pg 892
Leakage of Cerebrospinal Fluid
Fractures in the floor of the middle cranial f0ssa may result in CSF leakage from the ear (CSF otorrhea) if the meninges superior to the middle ear are torn and the tympanic membrane is ruptured. Fractures in the floor of the anterior cranial fossa may involve the cribriform plate of the ethmoid, resulting in CSF leakage through the nose (CSF rhinorrhea). CSF otorrhea and rhinorrhea may be the primary indication of a skull base fracture and present the risk of meningitis because an infection could spread to the meninges of the brain from the ear or nose.
Its Choice 3 Fractures of Middle Cranial Fossa.
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| indidoc1
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I didn't know its called battle's sign but leakage of CSF frm ear occurs in middle cranial fossa fractures.. So 3.
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| indidoc1
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I recall another thing...
There r differences between longitudnal n transverse fractures of the temporal bone in the base of middle cranial fossa..
Lemme try to recollect whatever i can.. Somehow, i don't quite remember where i read this.. So plz check these out b4 committing to memory..
Features of lonitudinal fractures.. CSF otorrhea, bleeding frm ear (tympaniic memb rupture) conductive hearing loss.. I don't remember well, but ithink facial nerve palsy association is also less..
Transverse fractures.. No CSF or blood (tymp memb intact), sensorineural hearing loss, Many times subclinical, i think facial nerve is injured more.
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| indidoc1
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BTW.. i ll be very grateful if someone cn summarise key features n modes of injury in cases of all skull fractures..
in fact, i m starting a new topic on this..
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| new_n_lost
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Yes in Longitudnal Injury there :-The facial paralysis is often delayed in onset, attributed to edema rather than direct interruption of the nerve. Vestibular involvement and sensorineural deficits are relatively uncommon and are attributed to concussive effects rather than direct trauma on the vestibular labyrinth and cochlea.
Where as in Transverse injury :-These fractures often require much greater energy and are more commonly associated with more serious or even fatal head injuries. The facial nerve is involved in 50% of cases. The otic capsule and internal auditory canal are frequently involved as well.
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| keepgoing
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what i do remember is that battles sign-->basilar skull Fx
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| kabootra
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3
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| keepgoing
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its 3 what is KLM nnl btw?
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| new_n_lost
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Keith L Moore Clinical Anatomy book
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| keepgoing
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thanks 
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| precious
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| lq2006
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3
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| ShweHope99.9998
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Hey,
Looks who all are here. .....Indi,..... good to see , you're studying hard.
At CS class , in ? head injury or , ear CSF, fluid leak, have to check battle sign at back of ear at mastoid area & write in sp note , check temporal bone # too if battle sign on sp.
So .....Nnl ,
better read all KML or just do reference for q like this.
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| aml
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