What type of fracture should be suspected if a casualty has CSF draining from nostrils and ears, periorbital ecchymosis, and ecchymosis behind the ears?

The presence of cerebrospinal fluid (CSF) draining from the nostrils and ears, accompanied by periorbital ecchymosis (often referred to as "raccoon eyes") and ecchymosis behind the ears (known as Battle's sign), strongly suggests a basilar skull fracture.

A basilar skull fracture typically occurs at the base of the skull and is associated with injuries to the meninges, potentially leading to leakage of CSF through the ear or nasal passages. The drainage of CSF is particularly concerning as it indicates a breach in the protective barriers of the brain, which can pose significant risks for infection and further complications.

The periorbital ecchymosis is a classic sign that can develop due to blood vessel damage or pooling of blood around the eyes. Similarly, the ecchymosis behind the ears can signal trauma at the base of the skull and the resulting bleeding in these areas. Together, these clinical findings point towards the likelihood of a basilar skull fracture rather than injuries related to the cervical spine or fractures of the nasal or mandible regions, which would not typically present with CSF leakage or the specific bruising patterns described.