Prognosis
The consequences of a skull base fracture depend on possible complications. The more of them occur, the worse the prognosis is. If there is no dislocation and the meninges remain intact (no liquor leakage), a basal skull fracture usually heals without permanent damage.
A basal skull fracture can lead to consequences and complications if not treated properly. These include ascending infections, which can trigger meningitis, or the formation of a brain abscess. Consequences such as inflammation of the skull bones (osteomyelitis) are also conceivable after a fracture of the base of the skull, as is the development of a cerebrospinal fistula with connection of the meninges to the nose or ear, which in turn poses a risk of germs entering the skull.
A fistula formation between arterial and venous vessels with resulting tinnitus (ringing in the ears) is also possible. The consequential damages of a skull base fracture can vary greatly. The prognosis can also vary, depending on which consequential damage occurs.
However, most skull base fractures proceed without further complications. If, however, the meninges are injured and a leakage of cerebrospinal fluid (cerebrospinal fluid) occurs, medical intervention must follow immediately. The leakage of cerebrospinal fluid is usually noticeable in that a liquid secretion emerges from the nose (nasal cerebrospinal fluid).
The existing opening through the meninges is accompanied by a risk of infection, which is why treatment with antibiotics should be carried out. The consequences would otherwise be ascending meningitis (inflammation of the meninges) and a brain abscess, both of which can be fatal in the worst case. In addition, an infection can lead to an inflammation of the cranial bone (osteomyelitis).
A cerebrospinal fistula, i.e. a passage between the meninges and other structures with an external connection, can also form. This facilitates the entry of pathogens via the ear and nose. In addition to infectious consequences, there are also those caused by swelling or bleeding due to the injury.
If, for example, a vessel is injured, the cerebral pressure increases due to blood leaking into other tissues. This triggers symptoms such as severe headaches, loss of consciousness, cramps or even respiratory arrest. Patients who become unconscious due to a fracture of the base of the skull must therefore be given artificial respiration immediately, otherwise there is a risk of suffocation.
In the worst case, the attending physicians may have to place a patient in an artificial coma. An artificial coma is a long-term anaesthesia that is monitored by intensive care medicine. It is induced when there is an acute danger to life, for example, due to an existing infection with septic shock.
The shock is caused by an overreaction of the body or the immune system. The coma enables the body to calm down and the most important functions such as heart activity are monitored by intensive care medicine. In the case of special fractures, which also affect the eye socket, blindness can also occur if the optic nerve is pinched or injured.
A further consequential damage affecting nervous structures is facial nerve paresis (paralysis of the facial nerve). Here, damage to these nerves leads to paralysis of the facial mimic muscles. Hearing damage and disturbance of balance are also among the possible consequences of a fracture of the base of the skull, if the fracture line runs through the inner ear.
The development of tinnitus (whistling sound) is therefore favored. Furthermore, bleeding may occur not only within the skull, but also vessels that break through the bone itself may be injured. For example, damage to the internal carotid artery can cause severe bleeding.
To prevent the consequences of a basal skull fracture, dangerous situations associated with loss of control should be avoided (e.g. risky car journeys). In addition, appropriate protective measures should be taken, such as wearing a helmet for high-risk sports or wearing a seat belt when driving.
