Which of the following indicates a skull fracture?

• A. CSF leakage from the ears.
• B. Elevated blood pressure.
• C. Absent pupil response.
• D. Neck rigidity.

Answer: (A)

The main idea is recognizing signs that indicate a skull fracture, especially basilar fractures where the dura is breached. When the dura is torn, cerebrospinal fluid can leak from the skull openings. Leakage of CSF from the ears directly shows a connection between intracranial space and the exterior, making it a classic and specific sign of a skull base fracture. This otorrhea is often clear and may be confirmed with tests for CSF markers.

The other signs are not as specific to a fracture. Elevated blood pressure can occur for many reasons and isn’t a reliable indicator of a skull fracture. Absent pupil response points to significant brain injury or raised intracranial pressure, not to a fracture itself. Neck rigidity suggests meningeal irritation from meningitis or hemorrhage, rather than a fracture.

So, CSF leakage from the ears best indicates a skull fracture.