emDocs - June 6, 2019 - Authors: Pillai S and Desai S
Edited by: Koyfman A and Long B
..."Pearls and Pitfalls:
- Battle sign and raccoon’s eye may be delayed 6-12 hours or not present with BSF.
- Hemotympanum is typically first finding.
- Most complications of BSF like CSF leak, cranial nerve deficits, and sequelae of carotid/vertebral artery injury arise late and present after 48 hours.
- Consider abuse in elderly and children.
- Consider meningitis if prolonged CSF leak.
- No evidence for prophylactic antibiotics regardless of CSF leak.
- Consider CTA to evaluate for carotid artery injury regardless of cervical fracture.
- Missed CVI can lead to permanent neurologic sequelae or mortality in up to 50% cases.
- Avoid nasogastric intubation, nasopharyngeal suction / airway, and NIPPV if potential BSF."