A fracture of the skull base
A fracture of the skull base is one of the most dangerous injuries because it violated the integrity of the bones that protect the most vulnerable and important organ – the brain. Depending on the severity, location and characteristics of the fracture it can result or a slight concussion, or have the most severe consequences: coma, paralysis, death.
What is the fracture of the skull base?
The skull surrounds the brain, protecting it from any external influences. But she but she is not a monolith, but consists of several parts, formed by the individual bones. Conventionally, it is divided into the base and the arch.
The base of the skull – it is a vast portion formed by four bones:
- Occipital. Unpaired bone, which is located in the occipital area. Below that is the spine itself.
- Temporal. Paired bone forming the lateral surface of the skull.
- Wedge-shaped. Unpaired bone that forms the cheekbone and nose.
- The ethmoid bone. Unpaired bone that separates the nasal cavity from the cranium.
Thus, the base of the skull is the lower part of the skull, consisting of five fused bones.
Causes of basilar skull fracture
A fracture of the skull base is a rare injury. In the General structure of traumatic brain injury it is about 30% to such damage in the fight, with severe trauma to the temporal region or in the nose, when falling from a great height.
But the most common cause of skull base fractures is car accidents, especially occurring at high speed.
Despite the fact that in ordinary life, a basal skull fracture – a rare injury, it is one of the most common causes of death racers. In total in the history of the competition there were several dozen of such incidents. Now all the cars participating in these races, mandatory use special devices that protect the head and neck from injury.
The severity of the injury
Traumatic brain injuries are among the most dangerous and difficult because of the large variety of consequences.
The brain is a very complex and delicate organ and any damage which may have fatal consequences. Therefore, it is protected by several kennels.
The skull protects it from physical impact to the environment, but it is not attached to it. Between the brain and its walls have an additional layer of the meninges, and the cerebrospinal fluid. The brain is suspended in this fluid acts as a buffer. But beyond that, the meninges and the CSF protect the brain tissue against ingress of pathogenic microorganisms. Moreover, the tissue surrounding thepermeated by a dense network of blood vessels supplying the brain with oxygen and nutrients.
Therefore, the risk of fracture of the skull base depends on three factors:
- Mechanical damage of brain tissue: shaking or penetration of the fragments.
- Violation of the integrity of the meninges, ingested pathogens, inflammatory processes.
- Bleeding, especially when the fracture of the ethmoid bone.
Depending on the features of fracture, the consequences can be very different. If the meninges not damaged and the bones are not misaligned, then the consequence may be just a concussion.
The consequences of fracture of the skull base
This type of injury referred to is extremely difficult because of the peculiarities of localization. A favorable prognosis is possible only in cases where there is no displacement of the bones and inflammation. But there are complications:
- Concussion of the brain. Accompanies the injury in most cases. Its severity can vary from mild to severe, depending on the severity and location of impact.
- Inflammation. Often when the bone lesions of the skull base integrity of the meninges are disrupted, causing the cavity of the brain can obtain the message from the nose, mouth or ear canals. Through them, penetrate the microorganisms that can cause meningitis and encephalitis. Therefore, the fracture of the skull base is one of the most common traumatic causes.
- Bleeding. In some forms of such a fracture can cause severe internal bleeding. But first of all it concerns the destruction of the temporal bone, which could damage the internal carotid artery.
- Headaches. People who have suffered such a fracture, in some cases, there are severe headaches, migraines.
- Epilepsy. This disease can also be a consequence of brain injury.
- Coma. With heavy damage high enough probability of occurrence of the coma.
- Death. In severe fractures death may occur within hours after injury.
The probability of a particular outcome depends on many factors, first and foremost – the exact point of impact, its type and strength.
The symptoms of fracture of the skull base
There are a number of characteristic features that allows to judge about the fracture of the skull base:
- Symptom Battle. He means bleeding into the mastoid process – a bit of exposed area behind the ear.
- Eyes of a raccoon. Also called "symptom points," or "traumatic points. When this occurs the hemorrhage okolovrusno tissue, which around both eyes there hemorrhage. But the same symptom may be accompanied by other States, in particular, the injury brow, nose orforehead.
- Liquorrhea. The so-called outflow of CSF (cerebrospinal fluid) in the area of the ear canal or nasal cavity. This occurs when violations of the integrity of the meninges and can cause severe complications, particularly inflammation of the brain.
- Bleeding from the ears or nose.
- Hearing loss, impaired vision.
If you notice such signs in the background of a head injury should immediately call an ambulance.
Diagnosis of injury
As a rule, the definition of the basilar skull fracture for the doctor is not particularly difficult. If in the near history of a head trauma, the pain at the point of impact, bruising around eyes and behind ears, symptoms of a concussion, the answer is obvious. However, to confirm the diagnosis and clarify the characteristics of fracture may need an x-ray, and in some cases – MRI.
But the primary information the physician may get much of the initial survey, in which he drew attention to the following indicators:
- Survey. First the doctor asked the patient if he is conscious, to clarify the circumstances of the injury, and especially its health.
- Check your reflexes. The doctor will determine the reaction of pupils to light, simple reflexes, in particular, the uniformity of smiles and deviation of tongue from midline.
- Inspection of the injury, determination of bleeding and the expiration of cerebrospinal fluid from the ears or nose.
X-ray study is carried out as quickly as possible. According to the standards required to make it in two projections, to accurately determine the displacement of the bones.
With a suspected fracture of the skull base will need to contact an ambulance or trauma. Patients with suspected sent him to the hospital to the neurosurgeon, especially if it requires surgical intervention. In addition, you may need a consultation and examination by otolaryngologist.
Treatment of fracture of the skull base
Treatment of skull base fractures depends on many parameters, primarily the severity of the injury.
If the bones of the skull fracture is not displaced and there is no violation of the integrity of the meninges, the treatment is conservative:
- The wound with a sterile bandage.
- Prescribed strict bed rest, it is very important that the head was lying on the dais, which improves the outflow of cerebrospinal fluid.
- The therapy of diuretics to reduce the amount of cerebrospinal fluid.
- In some cases, prescribe regular lumbar punctures to withdraw excess CSF and reduce the pressure on the brain.
Pay special attention to the prevention and treatment of inflammatory diseases of the tissues of the brain and its membranes. Are doingthe following steps:
- Debridement of the ear canal, nasal cavity and sinuses. To do this, they prophylactically treated with bactericidal solutions.
- Tamponade. If there was a communication between the nasal cavity and ear canals after rehabilitation spend their tamponade, i.e. block the access of microorganisms from the environment.
- Broad-spectrum antibiotics. Prophylactically prescribed antibiotics that affect most bacteria.
If these measures do not help and there are signs of inflammation, is assigned a more aggressive treatment, particularly the introduction of antibiotics directly into the spinal canal, through which they with the current of the cerebrospinal fluid into the brain.
But as may be required and surgical treatment: if the bones of the skull is fractured, if they are displaced, if damaged meninges, if formed a large hematoma. In this case, the neurosurgeon developing a plan of operations individually in each case.
Treatment of complications of fractures of the skull base is selected individually, depending on the severity and nature of damage.
First aid for fracture of the skull base
If you suspect a fracture of the skull base, you must perform the following sequence of actions:
- Call an ambulance! When brain injury medical assistance should be provided as quickly as possible.
- To clean the wound. If the impact left a wound, it must be rinsed with clean water or hydrogen peroxide, and to impose on it a sterile dressing.
- To restrict the movement. Such injuries can not move, best of all – just lie down and wait for the ambulance.
- To lay the victim. If he is conscious, you must lay on your back so that the head was elevated. If he is unconscious, you must lay on the uninjured side or on his back, but turning his head to the side. This requires that the vomit he choked on vomit.
- To unbutton clothes provide fresh air.
- To ease the pain, if applied to the site of the injury an ice pack.
Such actions will help to reduce the likelihood of further injury, but do not eliminate the need to obtain a full and qualified medical assistance.