Snapshot A 45-year-old man is brought to the emergency department after being found down in the park. The patient reports that he was physically assaulted by a group of men. Since then he reports episodes of rhinorrhea and occasional leakage from the ear. Physical examination is notable for periorbital and retroaurticular ecchymosis without evidence of a CSF leak. Non-contrast head CT demonstrates a basilar skull fracture but with no evidence of an intracranial hemorrhage. Neurosurgery was consulted, who recommended no surgical intervention but to be admitted for frequent neurological assessments. Introduction Definition login to view 1 more bullet Associated conditions login to view 7 more bullets Etiology high-velocity blunt trauma (e.g., motor vehicle collisions and pedestrian injuries) penetrating injuries (e.g., gunshot) Pathogenesis the location of the fracture predicts injury login to view 15 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 7 more bullets Imaging Noncontrast head CT login to view 5 more bullets Studies Making the diagnosis login to view 1 more bullet Treatment Managed expectantly login to view 1 more bullet Complications Meningitis CSF leak Cranial nerve palsies Cavernous sinus thrombosis