What are common signs of basilar skull fracture and an immediate precaution?

• A. Battle signs, raccoon eyes, CSF leak from ears or nose; immobilization and avoid nasal tube insertion if fracture suspected; imaging is required.
• B. Headache only; immediate imaging not needed.
• C. Battle signs, raccoon eyes, CSF leak from ears or nose; immobilization and avoiding nasal tube insertion if fracture suspected; imaging is required.
• D. Visual disturbance only; no special precautions.

Answer: (C)

Basilar skull fractures often show clues on the face and skull base, such as Battle’s sign (bruising behind the ear) and raccoon eyes (periorbital bruising), with possible leakage of CSF from the ears or nose when the dura is breached. These signs indicate a skull-base injury and risk of intracranial complications, so the immediate steps focus on safety and protection: immobilize the patient to prevent movement that could worsen any spinal or brain injury, and avoid inserting nasal tubes or performing nasal instrumentation if a fracture is suspected because a skull-base fracture can allow instruments to enter the cranial cavity. Imaging is then required to confirm the fracture and assess its extent and any associated injuries. The other options don’t align with these classic signs or the essential safety measures, such as stabilization and nonnasal instrumentation, making them less appropriate.