Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria

Study of Head Trauma through Computed Tomography

Objective

Primary brain injuries, which are the result of severe head trauma and cannot be prevented, are always catastrophic and fatal. Yet, if diagnostic and therapeutic steps are taken promptly after a craniocerebral injury, further brain insults may be prevented and the victim's death can be avoided within 24 hours.

Materials and Methods

Source of data, sample size, inclusion criteria, exclusion criteria, statistical methods.

Results

One hundred individuals with confirmed cumputer tomography (CT) scan results of severe head trauma participated in this analysis. Seventy men and thirty women accounted for the total number of patients. The research included 70% men and 30% women. The M/F ratio is 2.3:1. Males between the ages of 21 and 30 (a total of 21 patients) had the highest rate of head injury in our analysis. Males had a lower incidence overall, with nine cases in the 0-10 age range, 11 cases in the 11-20 age range, five cases in the 41-50 age range, three cases in the 51-60 age range, and four cases in patients older than 61. Similarly, eight of the female patients were in the 21-30 age range. There were also four patients between the ages of 0 and 10, four between the ages of 11 and 20, two between the ages of 41 and 50, five between the ages of 51 and 60, and three among those older than 61.

Summary and Conclusion

Men were more likely than women to sustain a head injury. The majority of the study population consisted of patients between the ages of 21 and 30 and 31 and 40. Injuries were found to most often occur in car crashes.

Basilar Skull Fractures and Their Complications in Patients With Traumatic Brain Injury

Objective

Since traumatic brain injury is more common in young people, who are the main workforce and builders of society, it is important to consider the effects caused by brain injury on them. In this study, we investigated the clinical manifestations, complications, and prognosis of patients with basilar skull fractures.

Methods

This cross-sectional study was conducted from March 2021 to March 2022 at the Kashani Hospital, Esfahan, Iran. Patients with basilar skull fractures were included in this study by census for one year. Recorded patient information was divided into two parts: demographic information, including age and sex, and disease information including loss of consciousness, signs of meningitis, need for surgery, and neurologic examination.

Results

In this study, 100 patients were included, of whom 89 were men. The most common complication was pain at the site of the trauma, followed by bruising and bleeding from the site of the trauma. Raccoon eyes and cerebrospinal fluid leakage were observed in 19% and 32% of the patients, respectively.

Conclusion

As the occurrence of trauma has an economic burden on the country's health system, we must identify its consequences and problems and prevent its occurrence as much as possible by implementing educational measures.

[Basilar skull fractures]

CLINICAL ISSUE

Basilar skull fractures are fractures of the lower part of the skull. They make up about 20% of all skull fractures and are mainly caused by high-velocity blunt trauma and falls from high heights. Depending on their precise location, they can be divided into frontobasal, laterobasal and frontolateral fractures. Possible clinical signs are the presence of cerebrospinal fluid rhinorrhea or otorrhea, periorbital ecchymosis (raccoon eyes), retroauricular ecchymosis (battle sign) and cranial nerve injuries. Furthermore, fractures of the petrous bone can lead to a conductive hearing loss, sensorineural hearing loss as well as dizziness and nausea due to a failure of the labyrinth.

PRACTICAL RECOMMENDATIONS

If there are any clinical signs of a basilar skull fracture, neurological deficits or limited consciousness (GCS < 15), a CT should be performed to rule out a basilar skull fracture and accompanying pathologies. In addition, if vascular injury is suspected, a CT angiography should be performed. Treatment is usually interdisciplinary and depends mainly on the accompanying injuries and possible complications. A purely conservative approach with close controls (with imaging) is often sufficient. The surgical approach is primarily used to treat possible complications, for example intracerebral bleeding.

Prevalence and pattern of basal skull fracture in head injury patients in an academic hospital

Background

Basal skull fractures (BSFs) have been reported to be a major cause of morbidity and mortality in the literature, particularly in young male patients. However, there are limited data available on the aetiology, prevalence and patterns of such observed in South Africa.

Objectives

To evaluate the prevalence and pattern of BSF in head injury patients referred to Dr George Mukhari Academic Hospital, Gauteng, South Africa.

Methods

Patients of all ages with head injuries were considered for the study, and those who met the inclusion criteria were scanned using a 128-slice multidetector helical computed tomography (CT) machine after obtaining consent. Data were prospectively obtained over a 6-month period, interpreted on an advanced workstation by two readers and statistically analysed.

Results

The prevalence of BSF in this study was found to be 15.2%. The majority of patients (80.5%) were under 40 years old, with a male to female ratio of 3:1. The most common aetiology of BSF was assault, which accounted for 46% of cases. The middle cranial fossa was the most frequently fractured compartment, while the petrous bone was the most commonly fractured bone. There was a statistically significant association between head injury severity and BSF, and between the number of fracture lines and associated signs of BSF (p < 0.001). The sensitivity of clinical signs in predicting BSF was 31%, while specificity was 89.3% (p = 0.004).

Conclusion

The prevalence and pattern of BSF found were consistent with data from previously published studies, although, dissimilarly, assault was found to be the most common aetiology in this study.

Analysis and Clinical Importance of Skull Base Fractures in Adult Patients with Traumatic Brain Injury

Aims and Objectives:

Basal skull fracture (BSF) is rare in head injury (HI) patients and occasionally goes unnoticed which may lead to cerebrospinal fluid (CSF) fistula. With changing trends in HI, there is a need to reassess incidence and pattern of BSF pattern, CSF leak, meningitis, and management protocol, especially in this part of the world where detailed literature is lacking.

Subjects and Methods:

We closely followed adult patients admitted with BSF in our institute between January 2013 and December 2014. Associated clinical features were recorded. In case of CSF leak, detailed CSF study was done and patients were managed accordingly. Patients with persistent CSF leak were managed surgically.

Results:

During the study period, 194 of 5041 HI patients had evidence of BSF (3.85%). BSF was most commonly associated with moderate-to-severe HI (73.19%). About 81.44% patients were male and 29.9% were <30 years. Most common cause was road traffic accident (84.54%). Isolated anterior cranial fossa (ACF) fracture was most common (50%). About 63.92% patients had raccoon eyes. Forty-three patients had CSF leak with CSF rhinorrhea being more common. Culture of only 5 patients suggested bacterial meningitis. CSF leak lasted for more than 10 days in 8 patients, of which 4 patients required surgical repair.

Conclusions:

BSF is rare in victims of HI. It is more common in young adult males. ACF fractures are most common in our setup. Clinical signs of BSF are supportive but not definitive; high resolution computed tomography head is gold standard to detect BSF. CSF leak is rare and most of the cases can be managed conservatively. Leak persisting more than 7–10 days has high risk of developing meningitis and likely to need surgical intervention.