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Head: fracture - basisphenoid/basioccipital

pequis

Synonym(s): Basilar skull fracture


Introduction

  • The basisphenoid and basiocciptal bones are located at the base of the calverium.  
  • Cause: these bones sustain damage most frequently when horses rear over backward or run into objects and strike the poll of the head.
  • Signs: vestibular signs, hemorrhage from nostrils or ear, behavior changes, seizures, tetraparesis.
  • Diagnosis: radiographs and CT scan of affected area.
  • Treatment: symptomatic based on clinical signs; aimed at decreasing intracranial pressure and supporting animal during recovery.
  • Prognosis: guarded to grave.

Pathogenesis

Etiology

  • Basilar skull fractures most commonly involve the basisphenoid, basioccipital and temporal bones.
  • Basisphenoid fractures occur at the suture between the basisphenoid and basioccipital bones resulting in compression of the brainstem.
  • Basioccipital bone fractures can result from an avulsion from the pull of the powerful ventral straight muscle of the rectus capitis ventralis on its insertion on the basioccipital bone or from direct impact.
  • Petrous temporal bone fractures may destroy the middle/inner ear resulting in vestibular signs and facial neuropathy.

Predisposing factors

General

  • Direct impact to the poll area or severe trauma to the calvarium.
  • Young horses (<12 months) are more susceptible due to their responses or reactions to restraint and due to the suture between the basisphenoid and basioccipital bones remaining open until 2-5 years of age.

Timecourse

  • Signs may be immediate following accident, or progress over the first 12-48 h as swelling increases following trauma.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Kramer J, Coates J R, Hoffman A G, Frappier B L (2007) Preliminary anatomic investigation of three approaches to the equine cranium and brain for limited craniectomy procedures. Vet Surg 36 (5), 500-508 PubMed.
  • Feary D J, Magdesian K G et al (2007) Traumatic brain injury in horses: 34 cases (1994-2004). JAVMA 231 (2), 259-266 PubMed.
  • Reed S M (2007) Head trauma: A neurological emergency. Equine Vet Educ 19 (7) 365-367 VetMedResource.

Other sources of information

  • Nout Y (2008) Central Nervous System Trauma. In: Equine Neurology. Eds: Furr M & Reed S. Blackwell Publishing, USA. pp 317-321.
  • Rush B, Reed L & Furr M (2008) Differential Diagnosis and Management of Cranial Nerve Abnormalities. In: Equine Neurology. Eds: Furr M & Reed S. Blackwell Publishing, USA pp 106-109.

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