Skull Fracture

What is a skull fracture?

A skull fracture, also called a cranial fracture, is a break in one or more bones of your head. Your skull is made up of bones that join together including the frontal, parietal, temporal, and occipital bones. Your skull protects your brain, nerves, blood vessels, and inner ears from injury. With a skull fracture, the protected areas may also be injured. Having your skull fracture treated may help relieve your symptoms such as pain, headaches, and dizziness. Treatment may also help prevent more serious problems, such as leaking fluid from your brain. Treating your skull fracture may also save your life.

What causes a skull fracture?

A skull fracture is normally caused by an injury to the head. Skull fractures commonly occur from any of the following:

• Being attacked and hit in the head with a blunt (not sharp) or sharp object. A sharp object may go through your skull bone.
  
  
• Falls.
  
  
• Gunshots.
  
  
• Motor vehicle accidents.
  
  
• Sports or other activities.

What are the signs and symptoms of a skull fracture?

Depending on what caused your skull fracture, you may have a head wound (break in the skin). Your head may also look misshapen. You may have headaches, dizziness, jaw pain, an upset stomach, or vomiting (throwing up). You may also have any of the following:

• Blood or clear fluid coming out of your nose or one or both of your ears.
  
  
• Bruising behind your ears or around your eyes.
  
  
• Facial drooping on one side. You may also have trouble moving one side of your face or closing your eye.
  
  
• Hearing problems such as ringing in your ears and hearing loss.
  
  
• Trouble moving your arms and legs, or raising your shoulders.
  
  
• Trouble moving your neck and neck pain.
  
  
• Trouble swallowing, decreased taste, and a dry mouth. You may also drool out of one side of your mouth.
  
  
• Uncontrollable eye movements. You may be unable to move one of your eyes, or it may be fixed (always looking) to one side. You may also have blurred or double vision.
  
  
• Voice hoarseness (rough).

How is a skull fracture diagnosed?

You may need any of the following:

• Imaging tests: You may need imaging tests to help your caregiver learn if you have a skull fracture. A dye may be given through your vein before some of these tests. The dye may help your caregiver see the pictures better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies.
  
  
  • Cerebral arteriography: A cerebral arteriography, or cerebral angiogram, is done to take pictures of the blood vessels in your head. Ask your caregiver for more information about cerebral arteriography.
    
    
  • Computed tomography scan: A computed tomography scan (CT scan) is a special x-ray using a computer to take pictures of your head. The CT scan may be used to look at your skull, brain tissue, and blood vessels.
    
    
  • Magnetic resonance imaging: During magnetic resonance imaging (MRI), pictures are taken of your head. An MRI may be used to look at your brain, skull, nerves, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.
    
    
  • X-rays: You may need x-rays of your skull to check for broken bones and tissue swelling.
  
  
• Ear exam: An ear exam may be done to check for bleeding or discharge from your ears. You may also need tests to check your hearing.
  
  
• Electroneurography: Electroneurography is a test done to check for damage to your facial nerves.
  
  
• Electromyography: Electromyography (EMG) is a test that measures the electrical activity of your facial muscles. Your facial muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your facial muscles.
  
  
• Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how alert you are. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.

How is a skull fracture treated?

You may have the following treatments alone or together:

• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Steroid medicine: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling. Steroids may be needed to decrease facial nerve swelling. Steroids may help improve any weakness or paralysis (unable to move) of your facial muscles. Steroids can help a lot but may also have side effects. Be sure you understand why you need steroids. Do not stop taking this medicine without your caregiver’s OK. Stopping on your own can cause problems.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Lumbar drain: A lumbar drain may be needed to decrease pressure in your head and brain. Increased pressure in your head and brain occurs when cerebral spinal fluid (CSF) builds up. CSF is the fluid around your brain. A lumbar drain is a tube put into your lower back that will stay there for a period of time. Your excess CSF fluid will drain out of the tube. The fluid may be sent to a lab for tests. These tests help check for problems such as infection, or bleeding around your brain and spinal cord. Ask your caregiver for more information about a lumbar drain.
  
  
• Spinal tap: A spinal tap is a procedure done to drain CSF fluid, and decrease pressure in your head and brain. During a spinal tap a needle is inserted into the lower area of your back. A small amount of CSF will be drained through the needle. The needle will be removed once your caregiver feels enough CSF has been drained. Your caregiver may send your CSF to a lab for tests. You may need more than one spinal tap. Ask your caregiver for more information about a spinal tap.
  
  
• Surgery: The injury that caused your skull fracture may also have caused an open wound (cut or sore) on your head. If you have a wound, you may need surgery to remove damaged tissues, and prevent infection. Surgery may also be needed to fix your damaged skull bones, or to remove pieces of bone. Pins, plates, or screws may be used to hold the bones together, or to keep your spine stable. Injuries to your brain, nerves, or blood vessels may also be treated with surgery.
  
  
• Halo traction: A halo is a special device used to keep you from moving your head and neck. Halos are often used if your skull fracture is unstable (movable). Unstable skull fractures needing a halo are often in the back (occipital) area of your skull. Ask your caregiver for more information about halo traction.
  
  
• Neck brace: A neck brace may be needed to prevent you from moving your head and neck. A neck brace may be soft or hard and helps prevent further injury while your fracture heals.
  
  
• Eye patch: You may need to wear an eye patch to help correct your vision or eye movement problems.
  
  
• Vestibular rehabilitation: Vestibular rehabilitation may be needed if you are having problems with dizziness. You may be given exercises to help your balance and decrease dizziness.

Where can I find more information?

Contact the following:

• Brain Injury Association
  1608 Spring Hill Road
  Vienna , VA 22182
  Phone: 1- 703 - 761-0750
  Phone: 1- 800 - 444-6443
  Web Address: http://www.biausa.org
  

When should I call my caregiver?

Call your caregiver if:

• People close to you notice changes in how you act.
  
  
• You have a fever (high body temperature).
  
  
• You have a headache.
  
  
• You have ear pain.
  
  
• You start to throw up.
  
  
• You have chest pain or trouble breathing that is getting worse over time.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have blood or fluid coming out of one or both ears.
  
  
• You have worsening neck pain.
  
  
• You had a seizure (convulsion).
  
  
• You have eye pain or swelling around your eyes.
  
  
• Your eye or eyes begin to bulge (stick out).
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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