The occipital bone is a part of the skull that protects the dorsal and lower parts of the brain from various injuries. It is formed by scales, articular condyles and the main body of the bone.
An injury to the occipital bone, whether it is a bruise or a fracture, is very serious. It can lead to serious consequences such as concussions and sometimes even death. Only immediate effective treatment will help avoid disastrous events. Let's look at the symptoms of an occipital bone injury, and also study the various types of its treatment.
general characteristics
Skull fracture - violation of the integrity of the bone due to traumatic injury
Fig. 1 Linear fracture of the squama of the occipital bone on the left (arrow).
Fig. 2 Linear fracture of the right occipital bone with slight displacement and a mantle-like subdural hematoma (arrow).
Possible complications and consequences
Complications, if any, make themselves felt over a period of several months to five years. Complications can be caused by various factors, ranging from improper treatment to an incorrect recovery course.
Complications after an occipital bone injury may be the following:
- paralysis,
- epileptic seizures,
- encephalopathy and mental dysfunction,
- cerebral hypertension, which can develop into a stroke.
Calvarial fracture
The “lightning bolt” symptom is characteristic of a fracture of the calvarium (two white arrows in Fig. 3), associated soft tissue swelling and soft tissue hematoma (arrow in Fig. 3a). The fracture line can bifurcate, but does not have branching, unlike the grooves of the arteries, which branch like a tree and taper upward (Fig. 4). “Step” at the site of divergence of fragments in a depressed fracture (arrows in Fig. 3c).
Fig. 3 Fracture of the occipital bone on the right (arrow). Symptom of “lightning” with a linear fracture of the occipital bone in the middle (arrows). Depressed multiple fracture of the left temporal bone (arrows).
Fig. 4 Fracture of the squama of the occipital bone, a fracture of the base of the occipital bone and a fracture through the apex of the pyramid of the right temporal bone (arrows). Linear fracture of the right temporal bone with transition to the right half of the frontal bone. Linear fracture of the right temporal bone with the presence of subarachnoid hemorrhage (arrows).
Fracture of the base of the skull
A fracture of the base of the skull is often a continuation of the fracture line of the vault (arrow in Fig. 5), and extension to the pyramid of the temporal bone is shown (arrow head in Fig. 5). The figure shows the passage of the fracture line along the scales of the left occipital bone, extending to the condyle (white arrows in Fig. 5).
Fig.5
Fig. 6 Linear fracture of the right temporal bone on MRI and CT, as well as the presence of a horizontal level of blood in the left half of the sinus of the main bone (yellow arrows).
Traumatic hemorrhage into the cells of the temporal bone (arrow in Fig. 7b), the cause of which was a linear fracture of the temporal bone, spreading along the scales of the temporal bone to the base of the skull. A fracture of the base of the skull passing through the sphenoid bone can lead to damage to the bone vessels or cavernous sinus, with hemorrhage into the sinus cavity (arrows in Fig. 7a). Fractures of the base of the skull can injure the oculomotor nerves with sharp edges and cause divergent strabismus (Fig. 7a), but the cause of such a disorder can also be damage to the midbrain.
Fig. 7 Fracture of the temporal bone with hemorrhage into the air cells and a fracture of the base of the skull with hemorrhage into the sinus cavity of the main bone.
First aid for a fractured head
If the victim is not given first aid for fractures and bleeding, a head injury can lead to irreparable consequences. However, here you need to be as careful as possible so that this help does not turn into even greater complications.
To help an injured person until qualified help arrives, you need to know what to do in case of an injury to the occipital bone. To do this, you should familiarize yourself with the following scenarios:
- The patient is conscious and does not have breathing problems. In this case, you should lay the victim on his back on a flat surface, immobilize his head and upper body, and apply an antiseptic bandage to the injured area.
- The patient is unconscious and has no respiratory distress. Then it is necessary to lay the injured person on his back and turn his head to the side. This will prevent aspiration in case of vomiting. You also need to unfasten tight clothes and get rid of jewelry.
- The patient's respiratory function is impaired. Here artificial respiration through a mask can help the victim. Cardiovascular drugs such as glucose solution or Lasix can also be administered.
Types of skull fractures
Linear fracture
Fig. 8 General view of a linear multiple fracture of the right occipital bone and right temporal bone on CT scan in SSD treatment. Linear extended fracture of the right occipital bone on 3D reformat (arrow). Linear fracture of the right temporal bone on MRI with subgaleal hematoma (arrow).
Fig. 9 Extended linear fracture of the right temporal bone on CT scan in SSD and VRT treatment. Vertical extended fracture of the squama of the frontal bone, blindly ending in the glabella region (reconstruction was performed from images with a thick slice - causes the presence of stepped artifacts on VRT).
Gunshot fracture
Consequence of a splintered wound with the formation of bone detritus in the left frontal region (white arrow in Fig. 10) and gliosis along the blind wound canal in the left frontal region and the basal ganglia on the left (white arrows in Fig. 10). A metal fragment (yellow arrows in Fig. 10) in the left occipital lobe with typical signs of stellate artifacts and signal loss artifacts in its immediate vicinity.
Fig.10
Depressed impression fracture
A cone-shaped fracture with fragments immersed in the cranial cavity occurs when struck by an instrument with an angular traumatic surface.
Fig. 11 Depressed comminuted fracture of the right parietal bone with fragments entering the cranial cavity, crushing of the brain matter in the vicinity of the fracture, pneumocephalus, laceration of soft tissues, presented on axial sections in the brain and bone windows, as well as on reconstruction in the sagittal, frontal planes and VRT.
Depressed depression fracture
A fracture with a uniform immersion of a bone fragment into the cranial cavity occurs when struck by an instrument with a wide traumatic surface. It is necessary to indicate the depth of depression of the fragment; if it is more than ½ the width of the diploe, surgical treatment with elevation of the fragment is necessary.
Fig. 12 Depressed fracture with a wide plateau, entering the cranial cavity by more than half the thickness of the diploe with the entire surface of the depression, presented on the axial and frontal planes, as well as a fracture of the squama at the base of the occipital bone at the foramen magnum on SDD, 3D (VRT) .
Hole fracture (perforation fracture)
A bone defect that occurs when injured by a sharp object (knife, screwdriver, etc.) is accompanied by the appearance of traumatic intracerebral hematomas (white arrow in Fig. 13), as well as an intracerebral traumatic hematoma of the right temporal lobe (yellow arrow in Fig. 13). There is a clearly visible defect in the right temporal bone in the form of an irregular hole from a traumatic object in 3D reconstruction.
Fig.13
Comminuted fracture
The consequence of severe TBI (a fall from a great height or an accident) is characterized by a large number of fracture lines and bone fragments, as well as severe brain damage, in this example, SAH and pneumocephalus (Fig. 14a). Figure 15 shows the consequence of a comminuted fracture (fracture lines are marked by arrows, in the frontal lobes there is a deposition of methemoglobin along the cortex - a consequence of SAH (arrowheads in Figure 15) and bone defects in the temporal regions on both sides of the bone resection craniotomy.
Fig.14
Fig.15
“Burst” fracture
A burst fracture is a consequence of compression exceeding the elasticity of the bones with the formation of radially diverging fracture lines (arrow heads in Fig. 17), as well as the possible formation of epidural hematomas (arrow heads in Fig. 16 and Fig. 17), subgaleal hemorrhages (arrows in Fig. 16 ) and the transition of the fracture to the sutures with their divergence (transition to the coronal suture on the left on VRT in Fig. 16 and the sagittal suture on VRT in Fig. 17).
Fig.16
Fig.17
Tennis ball or celluloid ball type fracture
A “tennis ball” fracture is characteristic of childhood, with preserved softness of the bone tissue and is accompanied by a uniform hemispherical deformation with depression.
Traumatic dehiscence of the cranial suture
Dehiscence of the seam occurs with significant impact force and often turns out to be a continuation of the fracture line extending onto the seam. Signs of seam divergence are step-like deformation at the seam site (arrow heads in Fig. 18) or its expansion (arrow heads in Fig. 19). Dehiscence of the suture may be accompanied by the formation of epidural hematomas and combined with anti-shock contusion lesions (arrows in Fig. 18).
Fig.18
Fig.19
Urgent Care
If a TBI is suspected, the victim must be taken to a medical facility as quickly as possible for diagnosis and treatment. Calling an ambulance is one of the first measures. If there is a wound with contamination, it should be treated with hydrogen peroxide.
Immobilization of the victim is a necessary condition. It is better to lay the victim on his back so that his head is elevated. Since vomiting often occurs with traumatic brain injuries, it is necessary to lay the patient’s head to one side to prevent vomit from entering the respiratory tract. After all, their aspiration is fraught with blockage of breathing, as well as the development of aspiration pneumonia, which worsens the general condition of the patient.
Headaches can be relieved with an injection of Ketorol or an ice pack, which reduces the intensity of bleeding.
Find out what to do in case of a traumatic brain injury: first aid for the victim.
Read how the symptoms of an open traumatic brain injury manifest themselves: diagnosis and treatment.
Recommendations: what to do if you have a head injury, how to provide assistance.
Changes in dynamics
In Fig. 20a fresh fracture of the squama of the occipital bone, arrow in Fig. 20b the same fracture ½ year later. The subgaleal hematoma above the fracture has regressed, and the diploe along the edges of the fracture is sclerotic, but there is no bone consolidation. In Fig. 20c there is bone hyperostosis on the inner surface of the diploe under the fracture site (yellow arrow) - this is a bone fusion that forms over the years, more often occurs in children, less often in adults. If glial changes develop in the brain under the fracture site, leading to the expansion of cerebrospinal fluid cysts, then the bones can move apart and the fracture is called “growing” (the same changes occur during the formation of a cerebrospinal fluid cavity - a cyst and an increase in intracranial pressure).
Fig. 20 Fibrous fusion with absence of callus and bone consolidation on CT.
Differential diagnosis
Groove of the meningeal artery and emissary veins of the diploe
Fig.21
In Fig. 21, the groove of the middle meningeal artery simulates a fracture, but unlike a linear fracture, it has a bifurcation (yellow arrow).
In Fig. 21, the outer plate and the thickness of the diploe are pierced by an emissary vein, which differs from the fracture by a cone-shaped depression on the surface and a layer of cortical bone along the edge (white arrow). The channels of the diploic veins in Fig. 21c are symmetrical and have dichotomous branching.
Spheno-occipital synchondrosis
Fig.22
Figure 22 (arrows) shows stony-occipital synchondrosis, which is not a fracture and heals by 15-18 years.
Cranial sutures and metopic suture
Fig. 23 Symmetrical and thin wedge-squamous sutures (arrowheads in Fig. 23a) can simulate a fracture of the base, but they are symmetrical and have a typical anatomical location, while noticing the fracture of the occipital bone and the lateral wall of the left orbit (arrows in Fig. 23a). A variant of the structure of the frontal bone may be the absence of its fusion during the formation process and the preservation of the metopic suture (Fig. 23b), which should be distinguished from a fracture (Fig. 23c)
Fig. 24 Emissary vein and fracture of the occipital bone (24a). The emissary vein on the frontal and sagittal reformat (24b) and arrowheads indicating “stepping” artifacts during the reconstruction of axial sections during the acquisition of which the patient moved.
Associated changes and indirect signs
Meningeal hemorrhages
Fig. 25 Epidural hematoma infratentorial in the left occipital region on CT and MRI (arrowheads) and fracture line (yellow arrow on MRI).
Linear fracture of the squama of the occipital bone on the left (arrow in Fig. 25) with damage to the diploic vessel and the formation of an epidural hematoma in the area of the left hemisphere of the cerebellum (arrowheads in Fig. 25).
Brain contusion (concussion lesions)
A skull fracture may be accompanied by brain contusions. Type III contusion lesions in the left frontal lobe and at the pole of the right temporal lobe (arrow heads in Fig. 26a and arrows in Fig. 26c). The line of the skull fracture (arrow head, Fig. 26c) is located opposite the brain contusions in the direction of the impact vector (dotted arrow, Fig. 26b).
Fig.26
Subaponeurotic hematoma. Hemorrhage into cells. Pneumocephalus
Fig.27
Fracture of the right temporal bone with the formation of a subdural hematoma (arrow in Fig. 27a) and a subaponeurotic hematoma in the left temporal region (arrowheads in Fig. 27a). Reduced pneumatization of the air cells of the temporal bone due to its fracture and hemorrhage (arrow head, Fig. 27b). Air in the cranial cavity (arrow head Fig. 27c) in the area of brain proliferation directly under the area of the impression fracture of the skull with damage to the integumentary soft tissues and dura mater (penetrating injury with the appearance of intracranial air).
Treatment of skull fractures
Fig. 28 Bone depression in the parietal bone on the right with the fragment immersed in the cranial cavity by 1/2 the thickness of the diploe on reconstruction in the sagittal, frontal planes and on VRT.
Fig. 29 Traces of extensive bone resection craniotomy in the right temporal region - emergency craniotomy for removal of an epidural hamatoma caused by a skull fracture.
Fig. 30 Plastic surgery of a large defect of the calvarium in the left frontotemporal region with titanium mesh at T1 and T2 (arrows).
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Author: radiologist, Ph.D. Vlasov Evgeniy Alexandrovich
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Diagnosis and treatment
To establish the extent of the lesion, an x-ray examination in two projections is necessary. Magnetic resonance imaging, CT, and ultrasound may also be needed. The neurologist examines and interviews the patient and witnesses to the incident. The main reflexes are checked: tendon, joint, pupillary.
Elimination of the consequences of traumatic brain injuries is carried out using drug therapy or surgery. Treatment consists of preventing infection of cerebrospinal fluid, brain, and bone tissue by microorganisms, preventing osteomyelitis, encephalitis, and arachnoiditis.
Therapy includes several measures:
- Applying a sterile dressing to immobilize the fracture fragments.
- If hematomas have formed, especially with herniation of the brain stem, its removal is indicated.
- Diuretic therapy, spinal canal puncture to reduce the manifestations of intracranial hypertension.
- Antibiotic therapy to prevent septic processes and infection of brain tissue.
- Wound tamponade.
- Treat bleeding with surgery or hemostatic drugs.
If a hematoma is detected on MRI, surgery is performed to remove it. The patient is indicated for craniotomy, since its formation is pushing aside the brain stem. In case of septic complications with the appearance of pus in the cerebrospinal fluid, the introduction of broad-spectrum antibiotics into the spinal cord cavity is indicated.