Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria

Abstract

Background:Basal skull fractures (BSF) in head injury may be missed clinically. Early detection ensures prompt treatment and prevention of complications We compared the clinical and Computed Tomography (CT) features of basal skull fractures in head injured patients in a southwestern Nigerian hospital.Materials and Methods:Head injury patients who had cranial CT at a Southwestern Nigerian hospital were selected. CT images were acquired with a 64-slice Toshiba Aquillion CT scanner using a standard head protocol. The images were evaluated for evidence of skull fractures, and associated complications. The clinical data and CT findings were analyzed.Results:One hundred and thirty patients were evaluated, including 103 (79.2%) males. Their ages ranged between 7 months and 81 years, mean 35 years (SD, 20.3). In 59 patients (45.4%, 59/130) BSF was detected on CT, while 71 (54.6%) had no evidence BSF. Forty-two (71.2%) of the 59 patients detected on CT had clinical suspicion of BSF (P < 0.001) while the remaining 17 (28.8%) were not clinically diagnosed. This equaled a sensitivity of 71.2% and, specificity of 90.1% for clinical determination of BSF in this study. There was no statistically significant difference between clinical and CT diagnosis (P > 0.05). The commonest observed clinical feature in patients with confirmed BSF was otorrhagia (45.8%) and the petrous temporal bone (45.8%) was the most commonly fractured bone. The BSF was caused most commonly by motor bike accidents in 53 (40.8%). The most common associated intracranial injuries were intracerebral haemorrhage (34.6%) and subdural (17.3%)Conclusion:It appears that neurosurgical evaluation is comparatively reliable in evaluating basal skull fractures in this study area even as they are consistently demonstrated by high resolution CT scanners. A clinical suspicion of BSF should warrant a closer detailed CT evaluation and reporting by radiologists.

Analysis and Clinical Importance of Skull Base Fractures in Adult Patients with Traumatic Brain Injury

“…Posterior cranial fossa fractures are rare likely due to thick occipital bone and tendency for falling forward following RTA. [ 19 ] This is the same reason why ACF and to some extent MCF fracture is more common.…”

“…Most of the published data are from the western and developed countries having lower prevalence of HI compared to underdeveloped and developing countries. [ 12 18 19 20 ] Traumatic CSF leakage is a complication in around 2% of all head injuries and in 12%–30% of all cases of BSF. [ 21 22 23 ] In our study, BSF incidence is 3.85% (194/5041) [ Table 1 ] whereas CSF leak was observed in 22.16% (43/194) of patients with BSF [ Table 5 ].…”

“…Various studies have revealed middle cranial fossa (MCF) to be most commonly involved in BSF which has been attributed to thin bones in MCF consisting of multiple foramina. [ 12 19 24 ] However, few others have reported ACF to be most common site of BSF. [ 18 25 ] In our study, fractures of ACF (50%) followed by multiple fractures (38.14%) and MCF (10.82%) were more common [ Table 3 ].…”

“…[ 26 27 28 29 30 ] Others have specifically stressed on importance of clinical signs suggestive of BSF. [ 19 31 32 33 ] According to Pretto Flores et al ., battle's sign and unilateral blepharohematoma (periorbital ecchymosis) had 100% positive predictive value (PPV) for detecting BSF while bilateral periorbital ecchymosis and otorrhagia had 70% PPV. [ 31 ] Savastio et al .…”

Prevalence and pattern of basal skull fracture in head injury patients in an academic hospital

“…3 Although most BSFs are thought to be minor in nature, if missed or diagnosed late, they could lead to debilitating complications such as neurovascular injuries, cerebrospinal fluid (CSF) leaks, meningitis or even death, especially if severe and/or associated with intracranial haemorrhage. 4–10 In fact, head injuries have not only been reported to be a major public health problem but are also a leading cause of morbidity and mortality in younger patients (i.e. those under the age of 45 years) in the developed world.…”