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Typical computed tomography slice for evaluation of basilar skull fracture. The mastoid air cells are clear of any fluid accumulation (A) and the petrous and squamous portions of the temporal bone (B) are intact.
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... 64-year-old man presented to the Emergency Depart- ment complaining of headache and bilateral ear pain after falling face first during a syncopal episode. He denied nausea, vomiting, or focal neurological complaints, and was alert and oriented, with blood-tinged fluid—which formed ‘‘halos’’ on the bed sheets—draining from both ears. A brain computed tomography (CT) scan with axial and coronal views was performed due to a concern for basilar skull fracture and was read as negative by the on-duty radiologist ( Figure 1). However, review of the study by the emergency physicians/case authors demonstrated bilateral comminuted fractures and dislocations of the mandibular condyles (Figure 2). The patient was admitted to the Oromaxillofacial Surgery service for re- pair of his injuries and was discharged the following morning. No basilar skull fracture was identified. The patient was well at 30-day follow-up. Otorrhagia is an uncommon finding with a limited litera- ture except for a longstanding association with basilar skull fractures (1). It has also been described in association with continuous positive airway pressure ventilation, trauma of various types including strangulation, internal carotid artery aneurysms, tumors, and tympanostomy tubes (2–5). Unfortunately, very few of these reports have appeared in emergency medicine journals (6,7). Other findings associated with basilar skull fracture are: Battle sign (postauricular ecchymosis), raccoon’s eyes (periorbital ecchymosis), and hemotympanum, but these may be delayed. Computed tomography may also miss the diagnosis that is often established ...
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Citations
... We report a rare manifestation of SAH in middle-aged woman. Otorrhagia in seldom found with limited literature available [8]. History of a trauma in these patients is very important, and some time otorrhagia is secondary to skull fracture [8]. ...
... Otorrhagia in seldom found with limited literature available [8]. History of a trauma in these patients is very important, and some time otorrhagia is secondary to skull fracture [8]. Simultaneous presentation of epistaxis and otorrhagia is a rare clinical finding. ...
Bleeding is a critical sign in many patients and continues or recurrent hemorrhage leads to emergency department (ED) visits. Epistaxis alone is a common problem, but when it presented with simultaneous otorrhagia become a very unpleasant event. Spontaneous epistaxis and otorrhagia necessitate imaging assessment to identification of underlying cause. A ruptured aneurysm or a possible underlying SAH should be evaluated by brain Computed Tomography. Advance diagnostic modalities for detection of underlying cause of SAH include: Computed Tomography Angiography, Magnetic Resonance Angiography and Digital Subtraction Angiography. A 57-years-old woman was referred to our tertiary hospital emergency department (ED) with otorrhagia and epistaxis. She had no history of headache, head trauma, hypertension and drug usage. In physical examination her vital signs were normal and Glasgow Coma Scale score on admission was 15. She had bilateral epistaxis and neurologic examination revealed no pathologic findings. ENT consultation was done, otoscopy reveal a normal tympanic membrane with bloody otorrhagia in the left external auditory canal. The epistaxis stop spontaneously and there was no finding on nose examination. She underwent further investigation for intracranial aneurysm or hemorrhage. Brain CT scan was performed and showed Sub Arachnoids Hemorrhage (SAH). She was candidate for brain CT angiography, which was normal. The patient, discharged from hospital after 1 week with stable vital sign and normal Brain CT scanning. A rare manifestation of subarachnoid hemorrhage: Case report, J Res Med Dent Sci, 2019, 7(1): 178-180
Crouzon's syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon's syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon's syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon's syndrome due to a ruptured jugular venous diverticulum is described.
