Skull Fractures

Skull Fractures Cranial vault fractures can occur after trauma in both open or penetrating nepenetrante, as in the case of closed trauma. Fractures extolling the virtues of high energies, which distorts the bone beyond its elastic limit. Fractures occur only if the elastic tolerance of the bone is exceeded. Skull fractures can result in subdural or epidural hematoma formation, producing cranial nerve. Also, after lesions, creating gateways for bacteria in cerebrospinal fluid, resulting in meningitis. Pneumocefalia can occur through air into the subarachnoid space. Skull fractures and directs the production mechanism of trauma intensity.
Skull fractures are classified as follows: - Fracture of skull vault. These in turn can be: linear fractures, burst fractures and fracture dehiscence. Linear fractures (single, branched or circular) is about 80% of all skull fractures, subdural hematomas are associated with or epidural. Other specific types of fractures that fall into this category are: cutting fractures, fractures disjunction, skull fractures explosions. - Base of skull fractures. They may be the floor above, middle or rear deck. - Joint Fractures. These are the cranial vault fractures that radiates to the base of the skull. Another classification divides them they skull fractures in closed fractures and open fractures, according to communicate with the outside world or not.
Cranial vault fractures usually occur in the frontal and parietal regions and less frequently in temporal and occipital. If you do not have complications, are devoid of any neurological symptoms. If there are complications as hemorrhage or cerebral contusion, then the appropriate form of the disease develop symptoms. Burst fractures of the cranial vault and segments that accompany the bone can cause clogging or dilacerari meningocerebrale compressions. Symptoms that develop depend on the location of the lesion. Usually symptoms of deficiency may occur or brain arousal, motor problems, sensitivity problems, seizures, aphasia. Fractures of the frontal bone fractures are usually clogging, causing damage to the paranasal sinuses, and the front of the orbits. If interested in olfactory nerve-ridden or blade, is anosmia (the inability to detect odors). Skull base fractures often are associated with fractures of the skull vault, but can occur in their absence as a result of energy acting on the middle cranial fossa floor or occiputului. They often locate in the middle fossa, parallel to or along the rocky bone sphenoid bone, to the Turkish saddle, and less frequently in the anterior and posterior pits. Complications from these levels are formidable and can meet pneumocefalia, cerebrospinal fluid leaks, caverno-carotid fistula.
Clinical signs and symptoms depend on the location of fractures. Skull base fractures often accompany the bleeding in the soft tissues of the head which are expressed through some bruising and swelling of eyelid (raccoon sign), ganglion hematoma, bruising in the mastoid area (Battle sign), hemotimpan signs (blood located in the middle ear). Cranial nerve damage can occur by sliding aside bone compression or by compression caused by a hematoma. The most commonly affected nerve is the optic nerve, followed by the olfactory nerve and vestibular nerve. Facial nerve can be affected, oculomotor and abducens common. Rock, bone fractures usually lead, facial nerve paralysis and dislocation of ear ossicles. Sphenoid bone fracture or injure the optic nerve will divide transversely, resulting in partial or complete unilateral blindness. Pupillary reflex of the affected eye is abolished. In partial lesions of the optic nerve meets frequently blurred vision, or appearance of the central scotoma paracentric and sectoral visual field defects. In the case of a direct orbital trauma occurs iridoplegie which is reversible, nearby objects are perceived unclear. Trohlear nerve damage by small wing of sphenoid fracture is seen clinically with diplopia only when looking down. Facial nerve is achieved in one third of cases of skull base fractures, especially in the rocky bone fractures, clinical manifestations can occur after trauma or later, after a few days. Late facial paralysis is usually a better prognosis than the paralysis that occur immediately. FRACTURES stones can cause bone and VIII cranial nerve injury, resulting in hearing loss, vertigo and nystagmus immediately after the injury. In case of deafness after a head injury, should consider making the differential diagnosis of deafness appeared perforated eardrum, through the accumulation of blood in the middle ear or middle ear ossicles deployment. Transverse fractures of bone and cochlea damaging stony maze. Cerebrospinal fluid outwardly in some cases the form of otoree (leaking fluid from the ears) or rhinorrhea (discharge of liquid through the nose after it traverses the ethmoid riddled blade). Persistent rhinorrhoea or recurrent meningitis indicate a perforation of the dura and emergency surgery must interveit. After meninges and frontal sinus lesion is found in some cases the brain substance leaks through the nose. As a result of bleeding often meet subarahnoid meningiana signs of irritation. Following fracture of the skull base location in the middle fossa may develop pulsating exophthalmos caused by a carotid-cavernous fistula. Skull fractures by clogging often dissipate crash energy through its takeover by bone fragments. It often accompanies neurological phenomena, but can cause cerebral contusion and focal neurological signs cortical area adjacent to the damage if the force of impact is very high.
In short, skull fractures are complications: - Septic complications: osteomyelitis, meningoencephalitis, MPM's subdural epidural or brain abscess. - Neurological complications: circumscribed cerebral contusion, intracranial hematoma, cerebral dilacerarea-duro, cranial nerve lesions, epilepsy. - Fluid complications: cerebrospinal fluid fistula - fistula ear, nose or mouth.
Diagnosis is suspected skull fracture on the basis of clinical signs and confirmed by imaging. Radiological diagnosis can be difficult because of the complexity of elements especially in the skull bone. If you notice a loss of cerebrospinal fluid by otoree, runny nose or wound must be detected based emergency could tear the meninges to intervene surgically. Headquarters drain cerebrospinal fluid (CSF) are detected by CSF instillation of water-soluble contrast followed by CT scanning. Other methods of detecting head meningeene rupture or radioisotopes are injected fluorescein in the cerebrospinal fluid, followed by collection of nasal fluid by buffering. If the tear is minor and CSF leaks in small quantities intermittently meningeeana rupture usually heals spontaneously. Turkish saddle fractures are usually difficult to diagnose radiologically. They are associated with paralysis of the optic nerves, the nerves VI and VII and pituitary dysfunction. Turkish saddle floor fracture is suspected by detecting the X-ray image of an air-fluid level in the sphenoidal sinus. In skull base fractures seen on a radiographic image of intracranial air collection, collection may be subdural, subarachnoid, intracerebral, intraventricular. Figure pneumoencefalon called. It occurs as a consequence of hypotension that occurs after fluid leak cerebrospinal fluid.