Which of the following signs indicates basilar skull fracture?

• A. Fever and chills
• B. Hemiparesis
• C. Nystagmus
• D. Battle sign, raccoon eyes, CSF rhinorrhea/otorrhea

Answer: (D)

Basilar skull fractures often present with signs tied to bleeding under facial tissues and leakage of cerebrospinal fluid. Battle sign (bruising behind the ear), raccoon eyes (periorbital ecchymosis), and CSF rhinorrhea or otorrhea occur when the dura is torn at the skull base, allowing CSF to escape into the nose or ear and producing visible drainage or a halo when tested. These findings are highly suggestive of a fracture at the skull base because they reflect dura involvement and communication with the subarachnoid space. Fever and chills point to infection, not a skull fracture; hemiparesis indicates a cortical or brain injury; nystagmus can arise from vestibular or brainstem issues but is not the classic sign set for basilar fracture.