If you have a basal skull fracture (where your skull joins the neck), your eyes bulge out and get bruised. This can damage the optic nerve and blind you. It’s called ‘racoon eyes’. It’s one of the symptoms that helps diagnose such a fracture, since it doesn’t show up on a CT/MRI.
Why does this happen? I’ve searched the web but found nothing.
My guess is that as around all fractures, there will be some swelling, and this moves the brain up, which in turn pushes the eyes out.
I doubt anyone on here knows this, but it’s worth a shot.
As this website shows, the occipital lobes (the part of the skull where it joins the back of the neck is the occipital bone) are concerned with vision.
I would therefore assume that the glassiness and ‘bulging’ are results of damage to the visual cortex.
Sorry, Firx but that’s not it. Trauma to the occiput transmits force thruout the basal skull, including to the area underlying the orbits of the eyes. There are natural stress lines there where fracture can occur, and if it does, it dumps lots of blood into the peri-orital tissue.
Damage to the visual cortex would effect vision itself, not the eyes.
Hmm, I suppose I could ask a doctor, but I doubt they’d know. They need to know that it happens not why happens.
Really shouldn’t be visiting too many of these medical sites though, since a basal skull fracture is what I have, and I’m gonna end up worrying about things I might have.
Also, I remember being told by a doctor that with the fracture, there is an excess of brain fluid. This means it might leak out through the ears or nose, and cause infection, leading to brain damage. That would suck, but I’m past that stage of going to happen so I’ve stop worrying! This excess of brain fluid could apply pressure on the eyes, pushing them forward.
Sorry, Harry, but it’s not the excess of brain fluid, it’s bleeding from the fracture. Trauma can damage the blood-brain barrier and lead to infection in central nervous system which can be fatal.
Well, Firx, unless you have advanced degrees in medicine and years of training in the subject, I’d hardly expect you to know off the top of your head. And we all come here to learn. Glad you’re participating!
Hey Pretend… did I hear you say you had a basal skull fracture? If so, * GET TO A DOCTOR!* That is, unless, you happen to have visited a doctor already or are currently in a hospital waiting room with a laptop. Then you should be ok as long as you go sign in. Make sure you do that, it’s as important as insurance.
Yeah, good advice oldman, but I’ve already been to a doctor, and I can’t remember my eyes being bulgy (PTA, it sucks), and didn’t really notice the bruising underneath them until I had it pointed out to me. That’s how observant I am. I’ve seen enough of doctors over the past few weeks, so I’m getting a bit bored of them.
The risk of infection is pretty much over for me now (I think and hope!), since the swelling’s going down, and there’s no excess of brain fluid, so I’m lucky.
Thanks Qadgop, I’m not too surprised that my guess was incorrect, not too knowledgable on the biology of the head. Also, I have another quick question for you. Is there any way that you can find out where abouts a basal fracture actually is? Since it doesn’t show up on CT or MRI, I was never told. I’d like to know, but it’s not too important.
Rightyho, gotta go. Thanks for your help everyone, harry
CT may miss a few basal fractures, but if the index of suspicion for a fracture is high, combining it with contrast, and/or doing an MRI with contrast certainly should turn up the abnormality.
It’s not called raccoon eyes, it’s called Battle’s Signs.
I witnessed an MVA rollover last summer, and placed my hands on the victim’s head less than 2 minutes after her car stopped moving. I had to sad fortune to watch them appear, along with seeing the two penetrating skull wounds.
It is called raccoon eyes. Battle’s sign is bleeding (ecchymosis) behind the ear (retroauricular). Raccoon eyes are periorbital.
It is NOT true, as implied, that CT and X ray are useless at picking up basilar skull fractures. A bad fracture (usually in the temporal bone) will show up on an X ray. CT is a good test for basilar skull fractures but you have to modify the settings to emphasize bone; you often see CSF fluid or other “indirect” evidence if you don’t see the actually fracture.
An MRI would certainly pick up most fractures. Any radiological test depends on the skill of the person reading it, and using thin enough slices to see what you need to.
CTs and other tests also CHANGE OVER TIME. The fact you don’t see it on day 1 doesn’t mean you would not see CSF fluid, say, after it has been leaking for a couple days. A bone scan would probably pick up something after some time.
That said, you can have serious brain injury with no fracture; and the fact there is a fracture would not change management of this condition in my emergency department if I suspected the diagnosis on clinical grounds (we’re a small hospital, and being in Canada, this means we don’t even have a CT scanner).
Dr_Paprika, I didn’t have an MRI scan, and they didn’t diagnose the fracure until I’d been for CT scans.
I guess I’m not going to find out where it is then! I was just curious, that’s all. Is there any way I could feel the swelling around it? Or is it all kind of hidden by my neck?
Dr_ Paprika, I know you’re a doc and I’m a lowly EMT, but both in my manual and in class we were shown where Battle’s Signs develop. Behind the ears and around the orbits. Or to use the correct phrasing you offered up, both retroauricularly and periorbitally.
Thank you for the clarification nonetheless. I will call my CIS Instructor this afternoon and ask him why we were taught this.
I hope you’d fly out a patient to a Level 1 Trauma Center, or the Canadian equivallent thereof, if presented with the symptoms outlined above.
EMTs do much sterling work in difficult conditions and are in no way lowly. But the ATLS trauma guide uses the same description I did, referring to Battle’s signs as retroauricular and raccoon eyes as periorbital. I don’t know what your instructor had in mind, but in practice, like so much in medicine, the different names don’t matter as much as making the diagnosis.
You could get a rough idea of where the fracture was, maybe, by using the symptoms outlined in Qadcop’s link. You might be able to feel it, too, but I’m guessing not if you’re unsure where it is.
Right, I have to go back for a checkup at my local hospital soon (not the one where I was treated, where they have a head injury ward, which is useful). I’m sure some part of it will be a CT scan, so I’ll ask them if they could possibly, pretty please, do another scan to see where the fracture is.
I dont suppose you know why they’d take out an earing of a patient, do you? My guess was that they’d take it out for an MRI, so it wouldn’t get ripped out because of the big magnet. However, I didn’t go for an MRI, so that throws that theory out of the window. Hmm, it just bothers me that I’m going to have to pay to get it repierced, which sucks.
