The infection and inflammation of the eye lids and the portions around the eye are commonly known as preseptal cellulitis or Periorbital cellulitis. Periorbital Ecchymosis commonly known as Raccoon eye is a symptom of basal fracture of skulls where the meninges are ruptured or are resultant of certain cancers. When ICP exerts enough pressure to displace a portion of the brain, herniation (an upward, downward, or lateral pushing of a portion of the brain through an opening) can occur. Herniation can also occur through a previous craniotomy site or through an opening caused by trauma. When ICP is elevated, an LP is contraindicated because the withdrawal of even a small amount of CSF can cause the brain to shift, or herniate.
After the original injury, a postconcussion syndrome may persist for several weeks to months.
A skull fracture may be open, closed, simple, depressed, or comminuted (fragmented), depending on whether the skull and scalp are intact.
Open skull fractures potentially expose the brain to external microorganisms, which could lead to meningitis or encephalitis.
In a basilar skull fracture, rhinorrhea, leakage of CSF from the nose (otorrhea), or leakage of CSF from the ear may occur.
Figure 78-7 illustrates the effects of a basilar fracture with periorbital ecchymosis (raccoon’s eyes) and periauricular ecchymosis (Battle’s sign).
An epidural hematoma is an accumulation of blood, usually from the temporal artery, between the dura and the skull (Fig.


FIGURE 78-7 · (A) Basilar skull fracture in the temporal bone can cause cerebrospinal fluid (CSF) to leak from the nose or ear (B) Periorbital ecchymosis, called raccoon’s eyes.
An intracranial (intracerebral) hematoma is caused by hemorrhage and edema that results from bleeding within the skull (Fig. Herniation causes severe injury to the brain because of prolonged hypoxia to parts of the brain that control the vital functions of the body—breathing and blood circulation. The concussion may not damage any brain structures, but temporary unconsciousness is possible. The brain may be hit on one side (coup) and then bounce (rebound) off the other side of the skull (contrecoup). Symptoms include headache, anxiety, fatigue, or vertigo (a sensation of rotation of self or one’s surroundings; not true dizziness). Lacerations are commonly associated with depressed skull fractures, which are discussed below.
The fracture breaks the bone and forces the broken edges to press against the brain, resulting in a significant risk for ClCP and meningitis.
A basilar skull fracture is especially dangerous because of potential damage to the vital centers that control blood pressure and respiration. The brain herniates (pushes) through the large foramen (opening) in the occipital bone, which lies between the cranial and spinal cavities.
A positive test for CSF is known as a halo sign (see In Practice: Nursing Care Guidelines 78-3).


The cause may be rupture of delicate blood vessels owing to hypertension or a cerebral aneurysm. Some clients recover from concussions with no apparent ill effects except the inability to remember the event; others have blurred vision or severe headaches.
With direct and rebound trauma, blood vessels, nerve tracts, brain tissue, and other structures are bruised and torn. Any scalp lacerations must be thoroughly examined to determine if the cranium has been opened. If, for example, the bone fragment presses on the brain’s speech center, the client’s speech may be impaired until the pressure is relieved.
Specific signs and symptoms are determined by the area of the brain affected and the extent of any neurologic damage.
A client who has had anything other than a very minor concussion should see a physician immediately for a thorough neurologic examination. Usually, the person is unconscious immediately after the injury, lucid for a brief period, then unconscious again as blood accumulates in the epidural space and causes pressure.



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