“Battle Sign” is a visual sign from a severe trauma to the skull resulting in a fracture and should not be taken lightly!
“Battle Sign” is the result of a “basilar skull fracture” or “basal fracture” (i.e. fracture of a skull at its base). Fractures of the skull at its base can include fracture of the bone behind the ears, at the base of the nose/nasal area and close to the spine. Basilar skull fractures are considered not only one of the most common but also one of the most severe types of fracture to the human skull. Trauma resulting in fracture of the aforementioned structures can place neurological and vascular tissue in the area at risk for injury which is why this type of fracture is considered a medical emergency!
One of the most apparent signs of a basilar skull fracture is the presence of distinct and severe bruising along the entire backside of the ears and possibly extending to the neck/cervical spine region. This is referred to as “Battle Sign”. Occasionally, individuals with Battle Sign may also present with “raccoon eyes” (i.e. bruising around the eyes). Additional signs related to Battle Sign can also include but are not limited to: clear fluid draining from the nose and/or ears, headache, dizziness and blurred vision. Due to its presentation, Battle Sign is often confused for a harmless bruise but, unlike a common bruise, it will not fade over time without other symptoms. Following a head trauma, Battle Sign may take a few days to present. One of the differentiating factors regarding the presentation of Battle Sign is that it appears at an area not directly related to the sight of injury, like a traditional bruise. The head trauma involved in producing Battle Sign can include sports, car accidents, falling off a bike without a helmet, motorcycle accidents as well as falls. These types of activities are very common in the spring and summer months and as such, we need to be very vigilant about the risk of head trauma and the presentation of Battle Sign.
Due to the risk of serious and possibly permanent neurological compromise, a suspected head injury resulting in Battle Sign warrants an immediate referral to the Emergency Room of a Hospital for assessment, treatment and monitoring. Proactively, this spring or summer, if you should be playing contact sports, riding a bike or operating a motorcycle, wearing a protective helmet is key to your safety!
Author: Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.