Summary The case of a one‐year‐old colt with acute onset of neurological dysfunction and epistaxis after a traumatic event is presented. After initiating emergency treatment, the colt was anaesthetised for diagnostic imaging. Radiographic examination of the head was suggestive of soft tissue opacity in the area of the guttural pouches, but was inconclusive about osseous involvement. A computed tomography (CT) scan, used to obtain further details, showed a comminuted basilar skull fracture with 2 displaced fragments that were not detected by radiography. Because of the poor prognosis for survival and return to athletic function, the horse was subjected to euthanasia. CT imaging provided the most useful diagnostic information about type, localisation, extension and severity of the basilar skull fracture.