Fracture of the base of the skull is a dangerous craniocerebral trauma, in which the brain envelopes, the canal of the spinal cord, the abundant loss of blood or liquor often occur, the important nerves responsible for the sight, hearing, facial expressions are infringed or torn. This condition is extremely dangerous: it often leads to disability and death.
Features of fracture of the skull base bones
Such a trauma can be independent, and may accompany a fracture of the cranial vault. In any of these cases, cracks in the bones forming the base of the skull are found: temporal wedge, occipital or latticed.
In severe cases, multiple cracks are found in several bones at once. Bones can also move, and their fragments can penetrate and injure nearby organs and tissues.
In any form of this injury, damage to the meninges can not be ruled out. If this happens, through the nasal passage, ears, orbits can form a passage through which the brain fluid and blood flows outward, and outward infectious pathogens penetrate. Microorganisms can infect the membranes of the brain, causing extremely dangerous diseases.
Splinters or sharp edges of broken bones can injure arteries and veins. In this case, the patient has bleeding through the ears or nose, there are "bruises" around the eyes, the blood can penetrate even into the eyeball. It is not uncommon for blood to enter the brain, which can cause irreversible consequences.
It is also possible for ruptures or impairments of the nerves responsible for hearing, vision, eye movement. Damage by fragments of brain areas located more deeply, can cause the appearance of personality disorders, impaired consciousness, memory loss.
The photo shows the main site of fracture of the base of the skull:
Fractures without displacement and single cracks are referred to as open CTB.Their treatment is the least difficult, and the forecast is most favorable. If there is a loss of blood or brain fluid during a fracture, it is referred to an open type CCT of a penetrating type.
Causes of skull base fracture
Bones that make up the base of the skull are damaged most often in the following situations:
- fall;
- any header;
- hit during an automobile accident;
- hit the bridge of the nose, the temple, the lower jaw with a heavy and hard object.
In children under one year on the foundation bone, almost always, cracks pass from the arch, which also traumatizes after falls or strong impacts.
It happens that expectant mothers are concerned about weakness and dizziness during pregnancy. Why is this happening and is it possible to avoid these unpleasant manifestations.
The popular method of treatment and prevention of Morton's neuromas today is orthopedic insoles. They are easy to use and give positive results. Read more. ..
Symptoms and signs
Each affected clinic of this fracture depends entirely on which of the bones was affected, where the crack is located, in which direction it is going, and how big it is, how many splinters there are.
Symptoms of a fracture of the anterior cranial fossa
Such fractures are characterized by:
- bleeding from the nose;
- discharge of the liquor through the nose;
- syndrome glasses: dark circles or "bruises" around the eyes.
Bruising in this case are formed in a day or three after the accident, which distinguishes them from normal bruises. If the geometry of the latticed bone is violated, the appearance of subcutaneous emphysema is often noted.
Symptoms of a fracture of the middle cranial fossa
Approximately half of the diagnosed skull base fractures in adults and 70% in children refer to bone fractures that form the middle cranial fossa.
In such a trauma, the canal of the facial nerve can collapse, the inner and middle ear may suffer.
Fractures of this localization are diagnosed according to such manifestations:
- unilateral ear bleeding;
- severe hearing loss or deafness;
- if the eardrum ruptures, the cerebrospinal fluid begins to flow through the ear;
- bruising behind the ear or on the temple;
- impaired sense of balance;
- dysfunction of the facial nerve;
- partial loss of a sense of taste.
Symptoms of fracture of the posterior cranial fossa
In fractures of such a localization, a longitudinal crack is most often found.
Diagnosis is made when there are such symptoms:
- bilateral or unilateral bruising behind the ears;
- concurrent defeat of the abducent, auditory and facial nerves.
Fractures in the bones that make up the posterior cranial fossa can cause damage or rupture of caudal nerves and the appearance of bulbar symptoms: paralysis or paresis of muscles of the tongue, palate, larynx. Functions of organs important for life can also be violated.
First aid
Fracture of the base of the skull is an occasion for urgent hospitalization, therefore at the first suspicions for its presence it is necessary to call a brigade "ambulance", which will be able to conduct the necessary qualified treatment.
While the brigade is expected to arrive, it is necessary to render first aid to the injured
if it is conscious and in a satisfactory condition:
- Lay it horizontally on a hard surface on your back without a pillow.
- Apply an antiseptic sterile dressing to the wound.
unconscious:
- Lay it horizontally on a hard surface on the back and slightly turn to the side, under the other side to lock the position by placing the roller( folded blanket).
- Head to turn to the side.
- Unfasten the pulling clothes, remove dentures, eyeglasses, jewelry.
- If breathing is not audible, artificial respiration is required.
If the delayed arrival of the emergency team caused by the wound is applied to the wound, cold is applied. Possible reception of diphenhydramine and analgin. Other painkillers, especially narcotics, are categorically contraindicated.
Treatment of
Fracture of the base of the skull requires mandatory preventive measures to prevent purulent complications: the patient is injected with antibacterial drugs intramuscularly, sanitizing the nasal and anuric cavities with antibacterial composition. Obligatory consultations are Laura, ophthalmologist, neurologist, surgeon.
Conservative methods
Effective for minor injuries: single cracks, fractures without displacement, and if the loss of cerebrospinal fluid can be eliminated without the help of a neurosurgeon.
The patient needs bed rest. In the supine position, the head should be raised upwards for the speedy elimination of the cerebrospinal fluid.
Therapeutic treatment includes dehydration( every 1-3 days there are punctures for the withdrawal of cerebrospinal fluid), the use of diuretics, which reduce the production of cerebrospinal fluid.
Prevention of purulent complications: sanitation of the auditory canal and nasal cavity with antibacterial drugs. After eliminating the outflow of cerebrospinal fluid, kanamycin is once endolyumbably administered.
In the presence of purulent complications, the antibiotic is administered intravenously, combining with endolumbal administration. For this, kanamycin, polymyxin, monomycin, levomycetin and other drugs are used.
All about the treatment of constriction of the vessels of the brain can be found in this article. The main symptoms and manifestations of pathology are also described here.
What are the causes and factors affecting the development of optic neuritis, read here.
And how is the removal of the neurinoma of the auditory nerve, it is written in the section which can be viewed at http: //gidmed.com/ bolezni-nevrologii /opuholi/ chem-opasna-nevrinoma-sluhovogo-nerva.html.
Surgical methods
Surgery is necessary in the presence of the following complications:
- multifragmental fracture of any bones;
- brain damage;
- nasal liquorrhea, which can not be stopped without surgery;
- some purulent complications;
- squeezing the brain.
The decision on the expediency of the operation is accepted by the neurosurgeon on the basis of the results of the conducted surveys.
Forecast and consequences of fracture of the skull base
Fracture of the arch and base of the skull is often accompanied by damage to adjacent tissues, so the prognosis of this condition is not always favorable.
A favorable outcome and absence of consequences is possible with a fracture without bias, single cracks that do not require surgical treatment, and absence of purulent complications.
If purulent complications occur( meningitis, encephalitis), the following conditions may develop in the future:
- encephalopathy;
- increases blood pressure of central origin, which can not be controlled;
- migraines and frequent headaches;
- periodic epileptic seizures.
Due to injury and disruption of connections between the skull and the spine, the spine may curl, at any degree and any part of it.
Partial or complete paralysis of the body is also possible if bone fragments damage the spinal cord, large nerve processes or parts of the brain.
The likelihood of complications and disappointing consequences can be reduced by taking the necessary measures in time, making a correct diagnosis and starting treatment as early as possible.
It is also important to follow the prescriptions of the treating neurosurgeon. Such actions allow us to hope for risk reduction and a favorable outcome of events.