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Base of Skull Fracture 15/12/10 SP Notes CLINICAL FINDINGS Periorbital ecchymosis (Raccoon eyes) CSF rhinorrhoea CSF otorrhoea Haematotympanum Brusing of mastoid (Battle’s sign) VIIth (facial paralysis) and VIIIth (hearing loss) CN dysfunction Battle’s Sign Racoon’s Eyes COMPLICATIONS Pneumocephalus from mask ventilation Tube positioned into the brain (NG or nasal intubation) Carotid artery damage: dissection, pseudoaneurysm, thrombosis Carotido-cavernous fistula (pulsating exophthalmus/orbital bruit) Caverous sinus thrombosis CSF fistula (within 1 week) Basal Meningitis Jeremy Fernando (2011) Panhypopituitism MANAGEMENT - risk = meningitis from direct contact of CSF to sinus, nasopharynx or middle ear - few RCT’s exist - no role for prophylactic antibiotics (doesn’t reduce the risk of meningitis) - frequent cultures of leaking or draining CSF should be taken (send for B2 transferin) and infections treated specifically - can prescribe antibiotics to cover insertion of ICP monitor Jeremy Fernando (2011)
