Battle's sign

Battle's sign is a physical finding that indicates the presence of a basilar skull fracture, a serious injury to the base of the skull. It is named after William Henry Battle, a British surgeon who first described this clinical sign. Battle's sign appears as a bruise (ecchymosis) behind the ear, over the mastoid process, and is typically not present immediately after the injury but develops one to two days later. The appearance of Battle's sign is a late sign of a basilar skull fracture and suggests the fracture has caused bleeding into the soft tissues in the area.

Causes and Mechanism

Battle's sign results from a fracture in the bones at the base of the skull, specifically in the region of the petrous temporal bone. The mechanism involves a force strong enough to fracture the skull base, leading to the accumulation of blood beneath the skin behind the ear. This type of fracture often occurs due to blunt trauma to the head, such as in vehicle accidents, falls, or physical assaults.

Symptoms and Diagnosis

In addition to Battle's sign, individuals with a basilar skull fracture may exhibit other symptoms, including cerebrospinal fluid (CSF) otorrhea or rhinorrhea (leakage of CSF from the ear or nose), hearing loss, vertigo, and cranial nerve deficits. The diagnosis of a basilar skull fracture is primarily based on clinical findings and imaging studies, such as computed tomography (CT) scans, which can provide detailed images of the skull bones.

Treatment and Prognosis

The treatment of a basilar skull fracture focuses on managing the symptoms and preventing complications, such as infections. In some cases, surgery may be necessary to repair the fracture or relieve pressure on the brain. The prognosis for individuals with Battle's sign and a basilar skull fracture depends on the severity of the fracture, the presence of associated injuries, and the promptness of treatment.

Complications

Complications of basilar skull fractures can include meningitis, due to the breach in the protective barrier of the skull allowing bacteria to enter the meningeal space, and brain abscess. Additionally, the leakage of CSF can lead to a persistent fistula, which may require surgical intervention to close.

Prevention

Preventing basilar skull fractures involves taking general safety measures to avoid head injuries, such as wearing seat belts in vehicles, using helmets while riding bicycles or motorcycles, and implementing fall-prevention strategies for older adults.

See Also

• Raccoon eyes
• Cranial nerve examination
• Head injury