Consequences of a basal skull fracture | Skull base fracture

Consequences of a basal skull fracture

The consequences of a skull base fracture depend largely on the possible concomitant injuries and (late) complications. An uncomplicated basal skull fracture without concomitant injuries or complications and without displaced fragments usually heals without consequences after a few days or weeks. The undesirable complications and consequences of a complicated skull base fracture include, for example, infection of the brain or meninges (encephalitis/meningitis), the increase in intracranial pressure with the risk of unconsciousness or respiratory and/or circulatory arrest, blindness due to tendonvein incarceration, bleeding from larger vessels with subsequent stroke symptoms, disturbances in balance and hearing, permanent tinnitus or complete loss of smell.

In addition, the risk of suffering an epileptic seizure or epilepsy increases over time, the more severe the trauma and the more complicated the fracture of the skull base. Normally, a fracture of the base of the skull heals without consequences and does not require medical intervention. This prognosis is particularly true if there is no leakage of cerebrospinal fluid, i.e. if the meninges are unharmed.

However, complications can occur that make therapy essential for survival. It also depends on these complications whether and to what extent permanent and reversible secondary damage occurs.Depending on the number and severity of complications, the prognosis varies between very good and very bad. If the meninges are damaged, liquor (cerebrospinal fluid) is usually discharged, which is usually noticeable by liquid secretion escaping from the nose (nasal liquorrhea).

In this case, antibiotic treatment should be administered, as otherwise the risk of developing ascending meningitis (meningitis) is increased. In addition, cerebrospinal fluid can cause a brain abscess to form as a result of an infection. Inflammation of the cranial bones (osteomyelitis) as a result of an infection is also possible.

In addition, a liquor fistula, i.e. a passage between the meninges or other structures with an external connection, can form, which ultimately promotes the entry of bacteria and other pathogens into the skull through the ear or nose. In addition to the consequences of a basal skull fracture caused by germs, the pressure in the brain can also increase due to swelling or bleeding after injury to a vessel. An increase in intracranial pressure represents a particular danger, since the brain reacts very sensitively to pressure.

The consequences can be a loss of consciousness, cramps or even respiratory arrest. In this case, there is an acute danger of suffocation and the patient must be ventilated. In general, if you suffer a fracture of the base of the skull, you may lose consciousness, and even then there is an acute danger of suffocation.

Further consequential damage can be the blindness of the patient, this danger is imminent if the fracture line leads through the orbit and leads to a constriction of the optic nerve. Another consequential damage affecting nervous structures is facial nerve paresis (paralysis of the facial nerve). If the facial nerve is paralyzed by being trapped by bony structures, this has extensive consequences.

For example, the entire mimic musculature is paralyzed. Besides the nerves, vessels can also be damaged. Here, the internal carotid artery is particularly worth mentioning; if it tears, this can lead to severe bleeding.

Depending on the fracture line, different structures are injured. If it passes through the inner ear, hearing damage and balance problems can occur. In addition, the development of tinnitus (a persistent whistling sound) is promoted.

If there is a particularly high risk and depending on the severity of the skull base fracture, the treating physicians may decide to place the patient in an artificial coma. Artificial coma is a long-term anesthesia that is monitored by intensive care medicine. It is used when the patient’s life is threatened.

In the case of very serious illnesses, such as a severe infection after a fracture of the base of the skull, the body often overreacts. The body’s own rescue systems are then completely overwhelmed by this enormous stress. The artificial coma protects the patient and calms the body. While all important body functions such as blood pressure and heart rate are monitored all the time, doctors can treat the patient more effectively.