Skull Fracture

What is a skull fracture?

A skull fracture is a break in one or more bones of your head. Your skull protects your brain, nerves, blood vessels, and inner ears from injury.

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 hit in the head with a blunt or sharp object

  • Falls

  • Motor vehicle accidents

  • Sports or other activities

What are the signs and symptoms of a skull fracture?

Signs and symptoms depend on the cause of your skull fracture. Your head may look misshapen. You may have headaches, dizziness, jaw pain, an upset stomach, or vomiting. 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

  • Drooping on one side of your face, or 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

  • Neck pain and trouble moving your neck

  • Trouble swallowing, decreased taste, dry mouth, or drooling on one side of your mouth

  • Uncontrollable eye movements, not being able to move one of your eyes, or blurred or double vision

How is a skull fracture diagnosed?

  • Imaging tests:

    • X-rays: You may need x-rays of your skull to check for broken bones and tissue swelling.

    • CT scan: This test is also called a CAT scan. An x-ray machine uses a computer to take pictures of your head. The CT scan may be used to look at your skull, brain tissue, and blood vessels. You may be given a dye before the pictures are taken to help caregivers see the pictures better. Tell the caregiver if you have ever had an allergic reaction to contrast dye.

    • MRI: This scan uses powerful magnets and a computer to take pictures of your head. An MRI may be used to look at your brain, skull, nerves, or blood vessels. You may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with any metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.

    • Cerebral arteriography: A cerebral arteriography, or cerebral angiogram, is done to take pictures of the blood vessels in your head.

  • 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 done to check for damage to your facial nerves.

  • Electromyography: Electromyography (EMG) 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. You may need to have your neuro signs checked often.

How is a skull fracture treated?

  • Medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Steroid medicine: This medicine helps decrease swelling.

  • Lumbar drain: A lumbar drain may be needed to decrease pressure in your head and brain. Increased pressure occurs when cerebral spinal fluid (CSF) builds up. CSF is the fluid around your brain. A tube is put into your lower back that will stay there for a period of time. The 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.

  • Spinal tap: A spinal tap is done to drain CSF fluid and decrease pressure in your head and brain. A needle is inserted into the lower area of your back. A small amount of CSF will be drained through the needle. Your caregiver may send your CSF to a lab for tests. You may need more than one spinal tap.

  • Surgery: Surgery may 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. If you have a wound, you may need surgery to remove damaged tissues and prevent infection.

  • Halo traction: A halo is a device used to keep you from moving your head and neck. Halos are often used if your skull fracture is not stable.

  • Neck brace: A neck brace prevents you from moving your head and neck. A neck brace may be soft or hard and helps prevent further injury while your fracture heals.

What are the risks of a skull fracture?

  • A lumbar drain, spinal tap, or surgery may cause an infection. With surgery, you may bleed more than expected. Your brain, nerves, and blood vessels may get damaged. You may have trouble controlling and moving your facial muscles, or you may lose feeling in areas of your face. You may get a blood clot in your leg or arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke.

  • Without treatment, your signs and symptoms may get worse. Your neck pain, dizziness, and eye or hearing problems may become permanent. You may lose your hearing completely. You may get a serious infection if fluid is leaking around your brain. Your nerves may be injured making it hard for you to speak or swallow. You may have trouble moving parts of your face. You may also have trouble moving your arms and legs. A skull fracture that is not treated can be life-threatening.

When should I contact my caregiver?

Contact your caregiver if:

  • People close to you notice changes in how you act.

  • You have a fever.

  • You have a headache that does not improve after you take medicine.

  • You have ear pain.

  • You are vomiting.

When should I seek immediate care?

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.

  • You have eye pain or swelling around your eyes.

  • One or both of your eyes begin to bulge.

  • You suddenly feel lightheaded and short of breath.

  • You have chest pain when you take a deep breath 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. 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.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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