Skull Fractures

Quick answer

A skull fracture is a break in one or more of the skull (cranial) bones.[1] MedlinePlus lists falls, automobile accidents, physical assault and sports among the causes.[1] Fractures are described as linear, depressed, compound or basilar, and they may occur along with a concussion or other brain injury.[1][2]

The skull and the brain

MedlinePlus explains that the skull provides good protection for the brain, but a severe impact or blow can cause it to break, and the fracture may be accompanied by a concussion or other brain injury.[1] The brain can be affected directly by damage and bleeding, or by bleeding under the skull that compresses brain tissue.[1] A skull fracture can also happen without a brain injury, and the brain can be injured without a fracture.[3]

Learn more: Traumatic brain injury · Brain bleeds

Types of skull fractures

Linear

A break resembling a thin line, without splintering, depression or distortion of the bone.[1]

Depressed

A break or “crushed” portion of skull with the bone pushed in toward the brain.[1]

Compound

A break in, or loss of, the skin together with splintering of the bone.[1]

Basilar

A fracture involving at least one of the bones at the base of the skull.[2]

MedlinePlus also uses the term “simple fracture” for a break in the bone without damage to the skin.[1]

Symptoms

MedlinePlus lists symptoms that may occur with a skull fracture, including:[1]

  • Bleeding from the wound, ears, nose or around the eyes
  • Bruising behind the ears or under the eyes
  • Drainage of clear or bloody fluid from the ears or nose
  • Changes in the pupils
  • Confusion, drowsiness or loss of consciousness
  • Seizures
  • Headache, nausea and vomiting
  • Balance problems, slurred speech or visual disturbances
  • Stiff neck and swelling

MedlinePlus notes that in some cases the only symptom may be a bump on the head, and that a bump or bruise may take up to 24 hours to develop.[1]

Basilar skull fractures

According to StatPearls, basilar skull fractures are relatively uncommon: they are present in about 4% of patients with a severe head injury and make up 19% to 21% of skull fractures.[2] Most are caused by high-velocity blunt trauma such as motor vehicle collisions, motorcycle crashes and pedestrian injuries, with falls and assaults also important causes.[2] They most commonly involve the temporal bones.[2]

StatPearls describes several exam findings that are highly predictive of a basilar fracture:[2]

  • Battle sign: bruising behind the ear over the mastoid bone
  • Raccoon eyes: bruising around the eyes
  • Hemotympanum: blood behind the eardrum
  • CSF leak: cerebrospinal fluid draining from the nose or ear

StatPearls notes that Battle sign and raccoon eyes are frequently delayed by one to three days, and that CSF leaks may also appear hours to days after the injury.[2]

Possible complications

StatPearls reports that basilar skull fractures are commonly associated with facial fractures, cervical spine injury, bleeding inside the skull, cranial nerve injury, vascular injury and meningitis.[2] Specifically:[2]

  • CSF leaks occur in up to 45% of patients with basilar fractures. Most resolve on their own within 5 to 10 days, but some persist for months.
  • Meningitis may occur in fewer than 5% of patients, with the risk increasing the longer a CSF leak lasts.
  • Middle ear injury is seen in nearly one-third of patients. Conductive hearing loss usually resolves within 7 to 21 days.
  • Injury to the facial nerve can cause facial droop, and injury to the hearing nerve can cause hearing loss or tinnitus.

How they’re diagnosed

NINDS notes that CT imaging can show a skull fracture and any bruising, bleeding or swelling of the brain.[4] StatPearls explains that the initial evaluation for a basilar fracture is usually a non-contrast CT scan, but linear or non-displaced fractures at the skull base can be hard to detect, and thin-slice CT may help find subtler fractures.[2]

Treatment and outlook

Treatment depends on the type of fracture and any associated injuries. StatPearls reports that nondisplaced basilar fractures are managed conservatively with good outcomes, while displaced fractures may require intervention.[2] Surgery may be needed for bleeding that requires decompression, vascular injury, significant cranial nerve injury or a persistent CSF leak.[2] StatPearls also notes that most patients with basilar skull fractures have some residual functional or neurological deficit that may take months or years to reverse.[2]

Skull fractures in children

MedlinePlus notes that epidural hematomas are often caused by a skull fracture during childhood or adolescence.[5] StatPearls’ review of pediatric skull fractures describes simple linear fractures as nondepressed breaks, and notes that compound fractures depressed by more than 1 cm carry a higher risk of injury to the brain’s surface and bleeding inside the skull.[6]

If someone else caused the injury

Skull fractures often result from crashes, falls and assaults. Imaging reports, hearing tests and records of any CSF leak or nerve injury can document the full extent of the injury. See Legal help after a head injury.

This page provides general information from the sources listed below. It is not medical advice and is not a substitute for evaluation by a qualified healthcare provider. In an emergency, call 911.

Sources

  1. MedlinePlus Medical Encyclopedia. “Skull fracture.” https://medlineplus.gov/ency/article/000060.htm
  2. Simon LV, Newton EJ. “Basilar Skull Fractures.” StatPearls, NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470175/
  3. MedlinePlus Medical Encyclopedia. “Head injury – first aid.” https://medlineplus.gov/ency/article/000028.htm
  4. National Institute of Neurological Disorders and Stroke. “Traumatic Brain Injury (TBI).” https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
  5. MedlinePlus Medical Encyclopedia. “Epidural hematoma.” https://medlineplus.gov/ency/article/001412.htm
  6. “Pediatric Skull Fractures.” StatPearls, NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482218/

Sources last checked: October 11, 2026

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