Raccoon eyes and Battle's sign are classic signs of which injury?

• A. Basilar skull fracture.
• B. Concussion.
• C. Orbital fracture.
• D. Facial fracture.

Answer: (A)

Raccoon eyes and Battle’s sign point to a basilar skull fracture. Periorbital bruising (raccoon eyes) and bruising behind the ear over the mastoid (Battle’s sign) occur when blood from a fracture at the skull base tracks into the soft tissues around the eyes and behind the ears. This combination is classic and suggests a fracture at the base of the skull rather than a simple facial or orbital fracture.

In practice, this means you should treat the patient as having a potential skull base injury, with attention to airway, cervical spine protection, and signs of possible CSF leak or cranial nerve involvement. Avoid nasal instrumentation if a basal skull fracture is suspected, and monitor for related complications. Concussion, orbital fractures, or facial fractures can cause bruising, but the specific pairing of bruising around the eyes and behind the ears is most characteristic of a basilar skull fracture.