Discussion
Discussion Temporal fractures may manifest with a CSF leakage from ear canal (otorrhea and bruises on the mastoid processes (Battle sign), whereas anterior variants may show characteristic hematomas around the eyes (raccoon eyes) and CSF rhinorrhea. Occipital condylar fracture has a much more severe course [9], usually resulting in coma. Condylar fractures are also associated with co-occurring cervical spine injuries potentially causing hemiplegia or quadriplegia. The injury of IX, X, XI, and XII cranial nerves with occipital condylar fracture is referred to as Collet-Sicard syndrome. A variety of symptoms may develop depending on the involvement of cranial nerves and related structures. Longitudinal temporal fractures are frequently resulting in the hearing apparatus damage and conducting deafness usually lasting longer than 6 weeks. However, hearing loss may be also caused just by the collection of blood (hemotympanum) and associated mucosal edema. In that case, deafness usually goes away in 3 weeks or less. Transverse temporal fractures tend to injure cranial nerve VIII causing permanent sensorineural hearing loss as well as nystagmus and ataxia. The co-occurring damage to the VII, VI, and V cranial nerves may manifest as facial paralysis and numbness as well as nystagmus. The Vernet syndrome is an injury of the IX, X, and XI cranial nerves in the jugular foramen and presents as vocal cord and palate paralysis on the ipsilateral side resulting in difficulties with speech. CT scan is an ultimate diagnostic modality for the skull fractures [13], having sensitivity of 85.4% and specificity of 100% [14]. Sagittal reconstruction with thin slices of 1-1.5 mm thickness is the optimal mode of CT scanning. Helical scan may be useful for evaluating occipital condylar fractures. CT scan is superior to other imaging studies. Some studies report CT scans missing up to 11.9% of skull fractures with a plain x-ray missing approximately 19.1% of them. However, plain x-ray may be useful for diagnosis of the fracture at the vertex, which tend to be missed more by CT.To ascertain the content of leakage from nose or ear as CSF, a “halo” sign may be tested. When dabbing the tested liquid on a tissue paper it will form a clear ring beyond the blood area. Laboratory testing of the liquid could also be performed as CSF contains certain amounts of glucose and tau-transferrin, which may differentiate it from other liquids.A complete physical examination must be performed on all patients with the particular focus on neurologic functions.