![]() ![]() CN VII - facial nerve - (ipsilateral facial movement, lacrimation, salivation, taste to anterior 2/3 of tongue, sensation around ear).temporal lobe injury (impaired hearing, comprehension, memory or seizure activity).cerebral cortex injury (upper motor neuron injury with contra lateral loss of motor function to face, upper and/or lower extremity ipsilateral blindness). ![]() supply of blood to anterior and middle cerebral cortex and ophthalmic artery.ipsilateral weakness of masticator muscles.CN V3 - 3rd or mandibular division of the trigeminal nerve (ipsilateral sensation of the mandibular region of the face).CN V2 - 2nd or maxillary division of the trigeminal nerve (ipsilateral sensation of the maxillary region of the face).loss of sensation to forehead, cornea or nare (loss of corneal reflex or nasal tickle response).ipsilateral pupillary dilation and loss of reaction.CN VI - abducens (ipsilateral movement of the eye in the temperal or lateral direction).CN V1 - 1st or ophthalmic division of the trigeminal nerve (ipsilateral sensation of the cornea, nare and forehead). ![]() CN IV - trochlear (contra lateral downward and medial eye movement).CN III - oculomotor (ipsilateral up and down eye movement, eyelid opening, pupillary constriction).impaired pupillary light response (CN II carries the light message to the CN III).CN I - olfactory (ipsilateral sense of smell).The following table summarizes the signs and symptoms. Symptoms of basal skull fracture include CSF leaks or bleeding into sinuses and canals and/or injuries to adjacent nerves. Bleeding from surrounding blood vessels can also enter these channels. When the base of the skull is fractured, disruption of the dura can allow CSF to leak into the sinuses or foramen that are close to the injury. A small component of the parietal bone (gray) extends under the brain to produce the lateral edge of the base of the skull. The anterior fossa consists primarily of the frontal bone (shown in brown), however, most of the frontal bone is covered in Diagram 2 by the maxilla (roof of the mouth, identified by blue). The temporal (pink) and sphenoid bones (yellow) make up the major structures of the middle fossa of the basal skull. The occipital bone (identified in green at the back of the skull) continues underneath the brain to produce the posterior fossa of the basal skull (Diagram 2). ![]() Posterior Fossa Fracture - echymosis behind the ear (battle sign), impaired gag reflexĬatastrophic injuries can occur if there is a major disruption of the carotid artery (blood supply to middle and anterior cerebral cortex) or vertebral artery (blood supply to brainstem and posterior cerebral cortex), or if the brain stem is disrupted. Middle Fossa Fracture - loss of sensation to lower face, ottorrhea, deafness, tinnitus, facial palsy, hemotympanium Clinical findings consistent with basal skull fracture are generally the result of bleeding or CSF leaks into one or more of these foramen or into the sinuses, or due to damage of the nerve that traverses the bony canals.Īnterior Fossa Fracture - anosmia, epistaxis, rhinorrhea, subconjunctival hemorrhage, periorbital hemorrage (raccoon eyes, visual disturbances, altered eye movement, ptosis, loss of sensation to forehead, cornea and nare The base of the skull contains a number of bony channels or foramen that permit the passage of blood vessels and nerves through the bottom of the skull. 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. Basal skull fractures are most frequently diagnosed by clinical findings, making clinical assessment skills critical. The base of the skull is identified by the red line in Diagram 1.īasal skull fractures are often not detectable with skull x-rays or even CT scan. The skull bones surround the entire brain, extending underneath to create the base of the skull. What are the clinical signs of basal skull fracture? ![]()
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