Snapshot A 45-year-old man is brought to the ED following a motor vehicle accident. He was not wearing a seatbelt and was ejected from the car through the windshield. On physical exam he was noted to have retroauricular ecchymosis, as seen in the image. Introduction Basilar skull fractures most commonly follow traumatic head injuries Presentation may be similar to traumatic brain injuries Presentation Physical exam periorbital ecchymosis (Racoon's Eye) retroauricular ecchymosis (Battle's sign) hemotypanium CSF leaks (rhinorrhea or otorrhea) VIIth nerve palsy (facial nerve) Evaluation Non-contrast CT scan Treatment In absence of the indications below, basilar skull fractures are allowed to heal without surgical intervention Indications for surgical management contamination mass effect on brain parenchyma CSF leak