Pathogenesis and mechanism of formation
The appearance of periorbital bruising is associated with damage to the bony structures of the skull. In fractures of the anterior cranial fossa, blood infiltrates soft tissues and cellular spaces, forming a characteristic pattern visually resembling glasses.
According to the classification of skull injuries, such changes may accompany various types of traumatic brain injury. Skull and brain trauma is frequently combined with deep ischemia of the scalp soft tissues, leading to local edema and endogenous intoxication.
Diagnostic significance and concomitant symptoms
The detection of specific hematomas requires an in-depth examination of the patient. Along with the raccoon sign, the clinical picture of skull base fractures may include:
- Battle's sign — bruising in the retroauricular region over the mastoid process (characteristic of middle fossa damage);
- Rhinorrhea — leakage of cerebrospinal fluid from the nasal passages in case of a dural tear;
- Otorrhea — leakage of cerebrospinal fluid from the ear in a fracture of the temporal bone pyramid.
It should be noted that fracture lines of the skull base are difficult to identify on plain skull radiographs, which is why clinical signs play a decisive role.
Patient management tactics in TBI
During the initial examination of a victim with suspected traumatic brain injury, the primary task is to assess the severity of the condition and the need for resuscitation measures. Individuals with polytrauma, catatrauma, road traffic accident victims, and patients with severe alcohol intoxication must undergo mandatory examination.
Instrumental diagnostics includes:
- Skull radiography in two projections — performed in all patients to search for cracks and fractures.
- Echoencephaloscopy — for the early detection of acute intracranial hematomas based on the displacement of midline brain structures.
- Lumbar puncture — performed exclusively after ruling out brain compression to prevent the risk of a fatal herniation and displacement.
Glasses-like bruising on the face after a head blow is a reason to urgently check the skull base (anterior cranial fossa) and rule out severe TBI.
Class and exam questions
What does the raccoon sign indicate in a victim with a head injury?
This sign indicates a high probability of a skull base fracture, specifically of the anterior cranial fossa, with hemorrhage into the orbital soft tissues.
When does the raccoon sign appear after an injury?
Bruising in the orbital region does not form immediately, but several hours or on the second day after a head injury.
What other symptoms accompany skull base fractures?
These include Battle's sign (hematoma over the mastoid process), nasal or ear CSF leakage (otorrhea/rhinorrhea), and hemorrhages in the occipital region.
What else to study on this topic
- Features of the clinical picture and the "lucid interval" syndrome in intracranial hematomas
- Differential diagnosis of subarachnoid hemorrhage using lumbar puncture
- Glasgow Coma Scale: assessment of the level of consciousness impairment based on motor and verbal responses
- Radiological diagnostics of subdural hematomas on computed tomography
- Clinical features and hidden risks of mild traumatic brain injury
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