Skull Fracture

A skull fracture is a break in a bone of the head.

Skull fractures can injure arteries and veins, which then bleed into the spaces around brain tissue. In people with a skull fracture, brain damage may be more severe than in people with a head injury but no fracture. Fractures, especially at the back and bottom (base) of the skull, can tear the meninges, the layers of tissue that cover the brain. Bacteria occasionally enter the skull through such fractures, causing infection and severe brain damage. However, a skull fracture often occurs without brain damage.

Certain symptoms suggest a fracture at the base of the skull: Cerebrospinal fluid--the clear fluid that flows over the surface of the brain between the meninges--may leak from the nose or ears. If the eardrum is ruptured, blood may collect behind the eardrum or blood may drain from the ear. Bruises may develop behind the ear (Battle's sign) or around the eyes (raccoon's eyes). Blood may collect in the sinuses; it can be detected by x-rays, computed tomography (CT), or magnetic resonance imaging (MRI). Seizures may occur soon after the injury or later.

Many skull fractures do not require surgery. Depressed skull fractures are an exception. In this type of fracture, one or more fragments of bone may press inward on the brain, damaging the brain. The brain may be exposed to the outside. To prevent infection and the formation of abscesses, doctors remove foreign materials and dead tissue and repair as much of the damage as possible. They lift skull fragments back into position and stitch the wound closed.