What are they and how do you recognize them?
Skull and brain
The brain is protected by the bones of the skull. We speak of the vault of the skull for the upper part of the skull and the base of the skull for the lower part of the skull. The boundary between the arch and the base follows a line that runs from the eyes to the top of the spine.
The vault includes part of the frontal bone in front, the 2 parietal bones, part of the 2 temporal bones on the sides, part of the occipital bone behind.
The base comprises the horizontal parts of the frontal bone, the 2 temporal bones and the occipital bone and, in addition, the ethmoid bone and the sphenoid bone. The base of the skull is divided into 3 pits: at the front, the anterior fossa, at the back, the posterior fossa, between the two, the middle fossa.
Skull fractures and brain damage
In the event of an accident and shock to the head, the skull and the brain can be damaged.
Shock can cause
- a fracture of the bones of the skull, with a possible displacement of a piece of bone towards the brain (fracture with depression of the skull);
- a head trauma, for example a concussion ;
- a brain contusion ;
- bleeding inside the skull (intracranial hemorrhage).
A shock to the head can cause general signs, for example disturbances of consciousness.
In the event of a fracture, in addition to possible general signs, there may be symptoms which depend on the location of the fracture.
- In the event of a skull base fracture, there may be a tear in the outer covering of the brain (dura mater) and cerebrospinal fluid leaking outward. Bacteria can pass into the skull and cause infection of the meninges (meningitis).
- In the event of a fracture of the anterior cranial fossa, at the level of the eye sockets and the upper part of the nose, there may be:
- a tear in the dura and cerebrospinal fluid leaking through the nose;
- a bruise (bruise) around the eye;
- loss of smell;
- visual disturbances.
- In the event of a fracture of the middle cranial fossa, at ear level, there may be:
- a tear in the dura and cerebrospinal fluid leaking from the ear;
- hearing loss;
- dizziness ;
- paralysis of the muscles of the face.
- In the event of a posterior cranial fossa fracture, there may be bleeding between the dura and the skull (extra-dural hematoma).
How is the diagnosis made?
In the event of an accident or head trauma, the doctor looks for a possible brain injury. If he thinks there is a serious brain injury, the person will still be sent to the hospital.
The doctor assesses the state of consciousness using what is called the ‘Glasgow scale’: this involves assessing the verbal response to questions, the motor response and the reaction of the eyes. Depending on the answers and reactions, he awards a number of points. The total of the points gives a score which reflects the overall state of consciousness.
The doctor also examines the size of the pupils and their reaction to light. The reaction of the pupils to light is different when the pressure increases in the head, which is the case with an internal brain injury.
Using a CT scan, the doctor can detect skull fractures and brain damage. A fracture with depression of the skull can be detected on palpation.
What can the doctor do?
A skull fracture rarely requires treatment. The bones are welded together in a short time. In children, the fracture can sometimes widen spontaneously. It will therefore be necessary to repeat the scan in children under 2 or 3 years of age.
The overall treatment of a skull base fracture is always done in the hospital. If cerebrospinal fluid leaks through the nose or ear, antibiotics should always be given to prevent meningitis. Most leaks stop on their own within 1 to 2 weeks. If the leak persists, a neurosurgeon will have to operate.
In the event of a fracture with depression of the skull, surgical treatment is necessary to replace the bone fragments if they exert pressure on the brain or if the injury is very visible (cosmetic reason). If the fracture is open, surgical treatment is needed within 24 hours due to the risk of infection.
Want to know more?
- The bones of the skull (images) – Larousse
- The scanner, here, Where to find on this page of Saint-Luc University Clinics (UCLouvain)
Source