Battle sign refers to bruising behind the ear.

Battle sign refers to bruising behind the ear.

• A. Bruising around the eyes
• B. Bruising on the chin
• C. Bruising behind the ear
• D. Bruising on the nose

Answer: (C)

Battle sign is a classic clue of basilar skull fracture, showing up as bruising behind the ear due to blood tracking to the soft tissues around the mastoid area after temporal bone injury. It tends to appear later, often 24 to 48 hours after the trauma, so its presence strongly suggests skull-base involvement even if there isn’t a large external wound. Recognizing this sign matters because basilar skull fractures can be accompanied by other serious problems, such as a CSF leak or intracranial injury, requiring careful monitoring and appropriate imaging and precautions. Bruising behind the ear specifically points to this skull-base injury, whereas bruising around the eyes—raccoon eyes—also signals possible skull base trauma but is a different sign. Bruising on the chin or nose is not the telling marker of a basilar skull fracture.

Battle sign is a classic clue of basilar skull fracture, showing up as bruising behind the ear due to blood tracking to the soft tissues around the mastoid area after temporal bone injury. It tends to appear later, often 24 to 48 hours after the trauma, so its presence strongly suggests skull-base involvement even if there isn’t a large external wound. Recognizing this sign matters because basilar skull fractures can be accompanied by other serious problems, such as a CSF leak or intracranial injury, requiring careful monitoring and appropriate imaging and precautions.

Bruising behind the ear specifically points to this skull-base injury, whereas bruising around the eyes—raccoon eyes—also signals possible skull base trauma but is a different sign. Bruising on the chin or nose is not the telling marker of a basilar skull fracture.