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Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Dec 22, 2012.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    What is your medical diagnosis ?

    Eyes.jpg
     

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  2. dupuytren

    dupuytren Bronze Member

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    racoon eyes--> basal skull fracture
     

  3. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    Typical sign of fracture cranii regio basilaris.
     

  4. Rocket Queen

    Rocket Queen Super Moderator

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    Basal skull fracture
     

  5. neo_star

    neo_star Moderator

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    The guy in the image looks like he has had a significant trauma to his head that could have resulted in a skull fracture.

    Now the question is whether racoon eyes is more commonly associated with basilar skull # ( since most if you seem to have gone for basilar skull # ) or fracture of cranial vault. For a start, basilar skull fractures are less common ( 5 - 6 % ) than vault fractures ( approx - 95 % )

    In case of Basilar skull # the periorbital ecchymosis is usually unilateral ( unless the fracture is bilateral ) and is associated with -


    • Battle's sign - is ecchymosis of the mastoid process of the temporal bone.
    • Cerebrospinal fluid rhinorrhea
    • Cranial nerve palsy
    • Bleeding from the nose and ears
    • Hemotympanum
    • conductive or perceptive deafness, nystagmus, vomitus
    • In 1 to 10% of patients, optic nerve entrapment occurs:[SUP][/SUP]the optic nerve is pressed by the broken skull bones, causing irregularities in vision.
    • Serious cases usually result in death

    In cranial vault fractures, the periorbital ecchymosis is usually bilateral ( typical racoon eyes ) and WHY is that so ?

    first a quick recall of the 5 layers of the scalp - 1) Skin 2) Dense subcutaneous tissue 3) Epicranius muscle and it's aponeurosis 4) Loose subaponeurotic tissue 5) Pericranium

    let's see what happens in a little detail with a cranial vault # - dura and pericranium tears --> blood from the intracranial hemorrhage communicates with the subaponeurotic space through the line of fracture --> even if the fracture is limited to one side, the blood will spread to both sides in the subaponeurotic space as this space does not respect laterality ( no midline partition ) ---> the blood in the subaponeurotic space, now slowly gravitates into the eyelids as the frontalis muscles has no bony atttachment ( usually to both eyelids, but more pronounced on the side of the # ).

    But is skull # the most common cause of racoon eyes ?

    Ans No

    Professional Boxers usually have black eyes 1 - 2 days following the end of an intense match. Is it because they have sustained a skull fracture ?

    Ans No

    It's usually because of the rupture of the emissary veins contained in the subaponeurotic space and the rest of the mechanism is same as explained for skull vault fracture.

    So my differentials in order of preference
    racoon eyes due to skull vault fracture
    racoon eyes due to basilar skull fracture

    Comments for or against are welcome (-:
     

  6. Gospodin Seki

    Gospodin Seki Moderator Staff Member

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    Basal skull fracture
     

  7. dr.angela

    dr.angela Bronze Member

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    fracture cranii regio basilaris
     

  8. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    Answer : Basal skull fracture

     

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