This clinical sign was noted in a patient involved in a motor vehicle accident.
a) What sign is shown below?
b) What does it indicate?
c) What associated signs support the diagnosis mentioned in Question 14.3 b?
A clinical photograph of Battle’s sign was supplied.
b) What does it indicate?
Base of skull fracture
c) What associated signs support the diagnosis mentioned in Question 14.3 b?
• CSF otorrhoea
• Haemotympanum
• Racoon eyes
• CSF rhinorrhoea
• Cranial nerve abnormalities
This image was misappropriated from the ACI website ( NSW Agency for Clinical Innovation).
Battle's sign (named after Dr William Henry Battle, rather than any association with warfare) apparently has a 100% positive predictive value for base of skull fracture.
Features associated with a base of skull fracture include several features which the college did not mention. I have tagged them on to the end of their list, for completeness:
Pretto, Flores L., C. S. De Almeida, and L. A. Casulari. "Positive predictive values of selected clinical signs associated with skull base fractures." Journal of neurosurgical sciences 44.2 (2000): 77-82.
Tubbs, R. Shane, et al. "William Henry Battle and Battle's sign: mastoid ecchymosis as an indicator of basilar skull fracture: Historical vignette." Journal of neurosurgery 112.1 (2010): 186-188.
Katzen, J. Timothy, et al. "Craniofacial and skull base trauma." Journal of Trauma and Acute Care Surgery 54.5 (2003): 1026-1034.
Samii, Madjid, and Marcos Tatagiba. "Skull base trauma: diagnosis and management." Neurological research 24.2 (2002): 147-156.