Skull fractures

There are two main types of fractures: fractures of the cranium, the main dome of the skull, and fractures of the base of the skull. A fractured cranium is often associated with concussion; because various blood vessels run directly beneath the cranium, there is a risk of epidural or subdural haemorrhage. If the bone is pushed inwards (impression fracture) there can be local brain damage with possible failure symptoms or epilepsy; otherwise few problems are caused. Diagnosis is by X-rays, and admission to hospital is recommended because of possible complications. Impression fractures are usually reset in the operating theatre. The base of the skull supports the brain, and various nerves and blood vessels run through it; thus laceration, as a result of fracture for example, can cause permanent failure of cerebral nerves. Fracture of the base of the skull is usually associated with concussion, and sometimes with cerebral haemorrhage. A general symptom is headache; if the fracture is at the front of the skull, the olfactory nerve can tear, with resultant loss of the sense of smell. Fracture of the eye socket can cause haemorrhage around the eyes. Damage to the optic nerve can cause diplopia (double vision); damage to the auditory nerve can cause deafness and possibly vertigo. Damage to the facial nerve causes paralysis on one side of the face. If the above-named nerves fail gradually after an accident they are probably trapped by oedema (accumulation of fluid) and recovery is possible. Tearing of the outer cerebral membrane can cause loss of cerebral fluid via nose, mouth and ear. Leaks of this kind often close spontaneously within a week. A possible complication is meningitis. Diagnosis is from the above-mentioned symptoms. An X-ray does not always reveal this fracture, although a CAT scan will. Treatment is in hospital and consists above all of rest. A fracture continuing into the face is corrected surgically, and leakage of cerebral fluid not sealed spontaneously is also treated in this way.

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