Basal Skull Fracture Diagnosis
The patient presents with specific signs following a head injury sustained in a road traffic accident:
- Consciousness: GCS 14/15 (indicating mild impairment).
- Ear Bleeding: Suggests possible temporal bone involvement or middle ear trauma.
- Nasal CSF Leak (Rhinorrhoea): Indicates a potential breach in the skull base, allowing cerebrospinal fluid to escape.
- Bruising behind the ear (Battle's sign): A classic sign associated with fractures of the posterior cranial fossa, often involving the mastoid bone, which is part of the skull base.
This combination of signs, particularly the CSF leak from the nose and Battle's sign, strongly points towards a Fracture of the base of skull.
Clinical Diagnosis Reasoning
Let's analyze the options:
- Extradural haematoma: While a possible complication of head injury, it typically involves arterial bleeding and may present with a lucid interval. It doesn't specifically explain the CSF leak or Battle's sign as primary features.
- Fracture of the base of skull: This diagnosis directly correlates with the observed signs: bleeding from the ear, CSF rhinorrhoea, and Battle's sign are hallmark indicators of a break in the skull's base.
- Cerebral concussion: This is a functional brain injury, characterized by temporary neurological disturbance. It doesn't inherently cause visible signs like CSF leaks or specific bruising patterns like Battle's sign.
- Traumatic subarachnoid haemorrhage: This involves bleeding into the subarachnoid space. While it can occur with head trauma, the specific signs presented (ear bleeding, nasal CSF leak, Battle's sign) are more indicative of a structural fracture than just bleeding into the meninges.
Therefore, the most probable clinical diagnosis based on the clinical presentation is a fracture of the base of the skull.
Important Questions from Brain & Nervous System Surgery
Which of the following chromosomal abnormalities are associated with brain tumours?
1. Neurofibromatosis type 1
2. Neurofibromatosis type 2
3. Peutz-Jeghers syndrome
4. Hereditary nonpolyposis colorectal cancer
Select the correct answer using the code given below.
Consider the following clinical features:
1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache
Which of the above clinical features are related to most brain tumours?
- The most common type of brain tumours associated with neurofibromatosis type 1 brain tumour syndrome is
Upper motor neuron lesions are characterized by which of the following?
1. Increased tone spasticity
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness
Select the correct answer using the code given below.
A comatose patient after sustaining severe head injury has been admitted in neurosurgical ICU. Which of the following parameters should ideally be maintained in this patient ?
1. $pCO_2 = 4.5 – 5.0$ kPa ($33-38$ mm Hg)
2. MAP = $80 – 90$ mm of Hg
3. $pO_2 > 11$ kPa ($> 80$ mm Hg)
4. $Na^+ < 130$ meq/L
Select the correct answer using the code given below :
