eMedicine Specialties > Neurosurgery > Trauma

Skull Fracture: Workup

Author: Nazer H Qureshi, MD, Chief of Brain and Spine Tumor Service, Baptist Health System, North Little Rock
Coauthor(s): Griffith Harsh IV, MD, Professor, Director of Neurosurgical Oncology, Department of Neurosurgery, Stanford Medical Center, Stanford University School of Medicine
Contributor Information and Disclosures

Updated: Nov 10, 2009

Workup

Laboratory Studies

In addition to a complete neurological examination, baseline laboratory analyses, and tetanus toxoid (where appropriate, as in open skull fractures), the diagnostic workup for fractures is radiological.

Imaging Studies

  • Radiographs: In 1987, the skull x-ray referral criteria panel decided that skull films are suboptimal in revealing basilar skull fractures. Hence, other than a fracture at the vertex that might be missed by CT scan and picked up by a plain film, skull x-ray is of no benefit when a CT scan is obtained.
  • CT scan: CT scan is the criterion standard modality for aiding in the diagnosis of skull fractures. Thinly sliced bone windows of up to 1-1.5 mm thick, with sagittal reconstruction, are useful in assessing injuries. Helical CT scan is helpful in occipital condylar fractures, but 3-dimensional reconstruction usually is not necessary.
  • MRI: MRI or magnetic resonance angiography is of ancillary value for suspected ligamentous and vascular injuries. Bony injuries are far better visualized using CT scan.

Other Tests

Bleeding from the ear or nose in cases of suspected CSF leak, when dabbed on a tissue paper, shows a clear ring of wet tissue beyond the blood stain, called a "halo" or "ring" sign. A CSF leak can also be revealed by analyzing the glucose level and by measuring tau-transferrin.

More on Skull Fracture

Overview: Skull Fracture
Workup: Skull Fracture
Treatment: Skull Fracture
Follow-up: Skull Fracture
Multimedia: Skull Fracture
References
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References

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Further Reading

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Keywords

skull fractures, linear skull fractures, basilar skull fractures, temporal fractures, depressed skull fractures, skull trauma, occipital condylar fractures, linear fractures, depressed fractures, vault fractures, fractures

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Contributor Information and Disclosures

Author

Nazer H Qureshi, MD, Chief of Brain and Spine Tumor Service, Baptist Health System, North Little Rock
Nazer H Qureshi, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, and World Society for Stereotactic and Functional Neurosurgery
Disclosure: Nothing to disclose.

Coauthor(s)

Griffith Harsh IV, MD, Professor, Director of Neurosurgical Oncology, Department of Neurosurgery, Stanford Medical Center, Stanford University School of Medicine
Griffith Harsh IV, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, California Medical Association, Neurosurgical Society of America, North American Skull Base Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry of New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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