Case Study para Kay Norhanna Ramber ) ) )
Case Study para Kay Norhanna Ramber ) ) )
Case Study para Kay Norhanna Ramber ) ) )
Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object that
goes through brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain
injury.
Mild traumatic brain injury may affect your brain cells temporarily. More-serious
traumatic brain injury can result in bruising, torn tissues, bleeding and other physical
damage to the brain. These injuries can result in long-term complications or death.
A basilar skull fracture is a break of a bone in the base of the skull. Symptoms may
include bruising behind the ears, bruising around the eyes, or blood behind the ear drum.
A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and may result in fluid
leaking from the nose or ear.
The base of the skull is a complex structure that forms the floor of the cranial cavity and separates the
brain from the head and neck. It is composed of the temporal, occipital, sphenoid, and ethmoid bones
as well as the orbital part of the frontal bone. These bones contain numerous openings, or foramina,
that allow cranial nerves and blood vessels to pass from one region to another. With skull base
fractures, these structures can become damaged, resulting in serious and potentially life-threatening
complications.
II. PROFILE OF THE PATIENT
PATIENT’S INFORMATION
FIRST NAME:
LAST NAME:
SEX:
AGE:
VITAL SIGNS:
PATIENT’S COMPLAINT:
III. ETIOLOGY
Most basilar skull fractures occur in the setting of severe head traumas, such as those
caused by motor vehicle accidents, motorcycle crashes, or pedestrian injuries. Other less
common causes include falls, penetrating injuries (e.g., gunshot wound), and assaults.
Because of the high amount of force required to produce a basilar skull fracture, these
types of fractures are more common in young individuals who are more likely to take part
in high-risk activities (e.g., rock climbing, skydiving, bungee jumping, etc.)
A basilar skull fracture is a break of a bone in the base of the skull. Symptoms may
include bruising behind the ears, bruising around the eyes, or blood behind the ear drum.
A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and may result in fluid
leaking from the nose or ear.
IV. SIGNS AND SYMPTOMS
Clinical features of basilar skull fractures vary depending on the degree of the associated
brain and cranial nerve injury.
Patients may present with altered mental status, nausea, and vomiting. Oculomotor
deficits due to injuries to cranial nerves III, IV, and VI may be present. Patients may also
present with facial droop due to compression or injury to cranial nerve VII. Hearing loss
or tinnitus suggests damage to cranial nerve VIII.
Several clinical signs highly predictive of a basilar skull fracture include:
1.) Hemotympanum
Fractures that involve the petrous ridge of the temporal bone will cause blood to
pool behind the tympanic membrane causing it to appear purple. This usually
appears within hours of injury and may be the earliest clinical finding.
5.) Middle ear injury is seen in nearly one-third of patients and may present with
hemotympanum, disruption of the ossicles, hearing loss, and even CSF leak.
Basilar skull fractures most commonly involve the temporal bones but may involve
the occipital, sphenoid, ethmoid, and the orbital plate of the frontal bone as well.
VI. PATHOPHYSIOLOGY
LABORATORY STUDY
2.) X-ray
A diagnostic test that uses invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto film.
Step 1: Assess the severity of the skull injury. This will involve a thorough examination, including
imaging studies such as X-rays, CT scans, or MRI scans, to determine the type and extent of the
fracture.
Step 2: Manage pain and prevent infection. Pain management may include over-the-counter pain
relievers or prescription medications, depending on the severity of the pain. Antibiotics may be
prescribed to prevent infection, especially if there is an open wound or if bone fragments have
penetrated the skin.
Step 3: Observe for signs of brain injury. This may involve monitoring the patient's neurological status,
including their level of consciousness, pupil response, and motor function. Any changes in these areas
may indicate a brain injury that requires further evaluation and treatment.
Step 4: Determine the need for surgical intervention. If the fracture is severe, involves significant
deformity, or if there are bone fragments in the brain, surgery may be necessary to repair the fracture or
remove the fragments. This decision will be based on the patient's overall condition, the severity of the
injury, and the potential risks and benefits of surgery.
Step 5: Provide appropriate follow-up care. After the initial treatment, the patient will need ongoing
care to monitor their recovery and ensure that any complications are addressed promptly. This may
include additional imaging studies, physical therapy, or other interventions as needed.