4/29/2023 0 Comments Skull and bones islandA recent Cochrane review did not find sufficient evidence to recommend prophylactic antibiotics in patients with basilar skull fractures even in the presence of a documented cerebrospinal fluid leak. Patients with associated cerebrospinal fluid leaks, present in up to 45% of patients with basilar skull fractures, are often treated with prophylactic antibiotics to prevent meningitis, but there is no good evidence to support this practice. Surgical management is necessary for cases complicated by intracranial bleeding requiring decompression, vascular injury, significant cranial nerve injury, or persistent cerebrospinal fluid leak.īasilar skull fractures increase the risk of meningitis because of the increased possibility of bacteria from the paranasal sinuses, nasopharynx, and the ear canal making direct contact with the central nervous system. Otherwise, skull base fractures are often managed expectantly. Patients with intracranial hemorrhage require emergent neurosurgical evaluation. Those taking anticoagulants should be admitted to a facility with immediate neurosurgical capabilities and the ability to do frequent assessments of the neurologic decline, even if no hemorrhage is present on initial imaging. Patients with basilar skull fractures require admission for observation. In addition, nasal intermittent positive pressure ventilation (NIPPV) should be avoided as it may induce pneumocephalus. Nasogastric tubes and nasotracheal intubation should be avoided because of the risk for inadvertent intracranial tube placement. ![]() Associated cervical spine injury is common, so attention to cervical spine immobilization, particularly during airway management is necessary. ![]() ![]() A thorough trauma evaluation with interventions to stabilize airway, ventilation, and circulatory issues is the priority. ĬSF leak is not easy to diagnose and the fluid should be sent for analysis of beta transferrin.īasilar skull fractures are usually due to significant trauma. MRI may be useful in assessing nerve injury and in evaluating for a cerebrospinal fluid leak. Further imaging with CT angiography and venography (CTA, CTV) to assess for vascular injury should be considered in the acute setting. Pneumocephalus should raise the suspicion for a basilar skull fracture. Conversely, the detailed small neural and vascular channels visualized on MDCT may be misread as fractures. In patients where a high clinical suspicion for basilar skull fracture exists, multidetector CT (MDCT) thin-slice scanning through the face and skull base may aid in the detection of more subtle fractures. Unfortunately, skull-based fractures that are linear or non-displaced may be difficult to detect. The initial evaluation is usually via a non-contrast computed tomography (CT) scan. Plain x-rays are not sensitive to detect basilar skull fracture. Such cenotes were sacred places to the Maya, and Guillermo believes the cenote beneath the Pyramid may be the whole reason this city was built at this location.The diagnosis may be obvious on a physical exam in some cases. Descendants of the ancient Maya people are still around today and many of them live in their ancestral homelands where they make up the majority of the population.Chemical signatures of cacao have been discovered in Maya ceramic vessels, suggesting they used to drink a form of hot chocolate over 2600 years ago.Some people believe that the Maya calendar predicted that the world would end in 2012.The ancient Maya people used a complicated writing system involving more than 800 hieroglyphs and they used this to write books.The Maya are one of the few ancient groups known to have built a great civilisation in a tropical rainforest climate.Their pyramids and cities are still being discovered and a large 1,000 year old Maya pyramid was found beneath a hill in 2015.The earliest Maya settlements are dated to around 1800 BC.The Maya Empire was located in the tropical lowlands of what is now Guatemala and reached its peak power and influence around the sixth century AD.
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