--- title: "ENT Signs in Basilar Skull Fracture | Battle Sign, Halo Sign, Laugier Sign & Raccoon Eyes Sign" description: "ENT notes on signs in Basilar Skull Fracture - Battle Sign, Halo Sign, Laugier Sign and Raccoon Eyes." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/basilar-skull-fracture-battle-sign-halo-sign-laugier-sign-raccoon-eyes" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Otology"] video: "https://www.youtube.com/watch?v=Zy1RyoAGEgg" image: "https://media.theentresident.com/og-images/basilar-skull-fracture-battle-sign-halo-sign-laugier-sign-raccoon-eyes.png" --- # ENT Signs in Basilar Skull Fracture | Battle Sign, Halo Sign, Laugier Sign & Raccoon Eyes Sign ENT notes on signs in Basilar Skull Fracture - Battle Sign, Halo Sign, Laugier Sign and Raccoon Eyes. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=Zy1RyoAGEgg ## ENT Signs in Basilar Skull Fracture Several classical signs are seen in **basilar skull fractures**. In this post, we will discuss: * Battle Sign * Halo Sign * Laugier Sign * Raccoon Eyes Sign --- ### Battle Sign #### 📌 Type of Sign 👉 Clinical Sign seen during **Examination of the ear**. #### 🔍 What is the Sign? Battle Sign refers to **bruising or ecchymosis over the mastoid region behind the ear**, appearing after head trauma. Seen in **Middle Cranial Fossa Fracture**. #### 🧠 Why Does it Occur? Blood from the skull base fracture **tracks into the subcutaneous tissues** behind the ear, producing a **bluish black discoloration** over the mastoid process. ⭐ Appears **6-24 hours after injury**. It is **never immediate**. #### 👨‍⚕️ Eponym Named after **William Henry Battle**, a British surgeon, who described mastoid bruising as a sign of basilar skull fracture. #### 💡 Mnemonic - The Four B's | B | Meaning | | --- | --- | | **B** | **B**attle Sign | | **B** | **B**ruise | | **B** | **B**asilar skull fracture | | **B** | **B**ehind the ear | 👉 Battle Sign is a **bruise** in **basilar skull fracture**, **behind the ear**. > What is the most common artery involved in middle cranial fossa fracture? > What is the artery involved in Battle sign? --- ### Halo Sign #### 📌 Type of Sign 👉 Clinical Sign A **bedside test** performed in suspected **CSF leak** (CSF otorrhea or CSF rhinorrhea). > What are the other names of Halo sign seen in CSF leaks? #### 🔍 What is the Sign? Halo Sign refers to a **double ring appearance produced when discharge mixed with CSF is dropped onto a filter paper**. #### 🩺 How is it Performed? The nasal discharge, often seen trickling when the patient bends forward, is allowed to **drop onto a piece of filter paper**. A **positive sign** is: ✅ A **central dark blood spot** with an **outer clear ring of CSF** #### 🧠 Why Does it Occur? CSF has a **lower viscosity** than blood, so it **diffuses further** on the filter paper. * CSF forms the **outer lighter ring** * Blood concentrates in the **centre** as a dark spot > What is the most common cause of CSF leak? #### ⚠️ Important Points ❌ Halo Sign does **not** confirm CSF - it is only **suggestive**. > What is the Gold standard test to confirm CSF? > What is the most common and deadly complication of an untreated CSF leak? #### ⚠️ Important MCQ Trap Do not confuse the two Halo Signs: | Halo Sign | Type | Seen In | | --- | --- | --- | | Halo Sign on filter paper | Clinical | Suspected CSF leak | | Halo Sign on CT Temporal bone | Radiological | Cochlear otosclerosis | --- ### Laugier Sign #### 📌 Type of Sign 👉 Clinical Sign seen during **Otoscopy**. #### 🔍 What is the Sign? Laugier Sign refers to the **presence of blood behind the tympanic membrane (hemotympanum) following trauma**. Seen in **Basilar skull fracture**, particularly **temporal bone fractures**. > Decribe the otoscopic findings of Laugier sign. #### 🧠 Why Does it Occur? Basilar skull fracture → Tear of the vessels in the **temporal bone** → Leaking of blood into the **middle ear cleft** → Discoloration of the tympanic membrane #### 👨‍⚕️ Eponym Named after Laugier, who described hemotympanum as a diagnostic clue in basilar skull fractures. #### ⚠️ Important Viva Point Hemotympanum is called **Laugier Sign only when it follows trauma**. > What are other Causes of Hemotympanum? --- ### Raccoon Eyes Sign #### 📌 Type of Sign 👉 Clinical Sign seen during **Examination of the eyes**. #### 📌 Also Known As 👉 Panda Eyes Sign #### 🔍 What is the Sign? Raccoon Eyes Sign refers to **bilateral periorbital bruising or ecchymosis**, giving a dark discoloration around the eyes. Seen in **Anterior Cranial Fossa Fracture**. #### 🧠 Why Does it Occur? Blood **tracks into the loose periorbital tissues** around the eyes. #### 🐼 Why is it Called Raccoon Eyes Sign? The dark discoloration around the eyes resembles the eyes of **a raccoon** or **a panda**, hence the names **Raccoon Eyes Sign** and **Panda Eyes Sign**. #### ⚠️ Important Viva Point | Sign | Site of Fracture | | --- | --- | | Raccoon Eyes Sign | Anterior cranial fossa | | Battle Sign | Middle cranial fossa | --- ### ⭐ High Yield Rapid Revision Table | Sign | Elicited By | Finding | Indicates | | --- | --- | --- | --- | | Battle Sign | Examination of the ear | Bruising over the mastoid, 6-24 hours after injury | Middle cranial fossa fracture | | Halo Sign | Discharge dropped on filter paper | Central dark blood spot with an outer clear ring | CSF leak (otorrhea / rhinorrhea) | | Laugier Sign | Otoscopy | Hemotympanum following trauma | Basilar skull fracture, especially temporal bone | | Raccoon Eyes Sign | Examination of the eyes | Bilateral periorbital ecchymosis | Anterior cranial fossa fracture | --- ### 🧠 Viva Pearls * Battle Sign is bruising over the mastoid region behind the ear. * Battle Sign appears 6-24 hours after injury and is never immediate. * Battle Sign indicates a middle cranial fossa fracture. * Halo Sign occurs because CSF has a lower viscosity and diffuses further than blood. * Halo Sign is only suggestive of CSF, not confirmatory. * A radiological halo sign is seen in cochlear otosclerosis, and should not be confused with the filter paper halo sign. * Laugier Sign is hemotympanum following trauma. * Raccoon Eyes Sign is also known as panda eyes sign. * Raccoon Eyes Sign indicates an anterior cranial fossa fracture. --- ## About This Note This free ENT note on ENT Signs in Basilar Skull Fracture | Battle Sign, Halo Sign, Laugier Sign & Raccoon Eyes Sign was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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