If there is a basal skull fracture, this can manifest itself as so-called liquorrhoea. This is the discharge of cerebrospinal fluid (liquor) from the nose or ear when the injury creates an open connection to the liquor-filled meninges surrounding the brain. In frontobasal skull base fractures, the cerebrospinal fluid usually emerges from the nose, whereas in laterobasal fractures it emerges from the ear.
CSF is a clear fluid that surrounds the brain. However, when it exits, it usually turns bloody due to the simultaneous injury to vessels. Not only cerebrospinal fluid leakage, but also various bleedings without cerebrospinal fluid admixtures can be a sign of a skull base fracture.
These include bleeding from the mouth, ears and nose or intracranial (within the skull). Special forms of bruising (haematomas) are also included. These are called spectacle or monocular hematoma, which refers to the bruising around the eye sockets.
In the case of spectacle hematoma, both eye sockets are affected, resulting in an image similar to that of a spectacle wearer. In monocular hematoma, on the other hand, only one of the orbits is altered; the patient resembles a monocular wearer. Bleeding can occur not only around the eye, but also behind the eyeball or behind the eardrum.
In these cases, if the eye is involved, it is called retroauricular bleeding (retroauricular = behind the eye) and if the eardrum is involved, it is called hematotympanum. The former form of bleeding can push the eyeball (bulbus) forward, forming a so-called protrusio bulbi (protrusio = bulge). A hematotympanum is characterized by blood accumulation in the tympanic cavity (contents = ossicles) behind the eardrum.
The clinical picture of a skull base fracture also includes failures of the cranial nerves, for example eye movement disorders, hearing loss, dizziness, blindness or olfactory disorders. Since the cranial nerves emerge at the base of the skull, they can be injured or constricted in the event of a fracture, which in turn leads to the described symptoms.
