Raccoon eye after basilar skull fractures from mild traumatic brain injury

Abstract

Introduction: Mild traumatic brain injury is highly prevalent; however, accurate diagnosis, standardized criteria, and clinical outcome assessment remain challenging. This study aimed to determine the frequency of raccoon eyes in patients with basilar skull fractures following mTBI. Methods: This single-center study included patients with basilar skull fractures following mild traumatic brain injury who were admitted to Al-Zahra Hospital between February 2024 and February 2025. A census sampling approach was used, and 21 patients were enrolled, with raccoon eyes assessed in each. Results: Among 120 patients with basilar skull fractures following mTBI, 21 (17.5) developed raccoon eyes, including 11 cases (52.4) with unilateral presentation and 10 cases (47.6) with bilateral involvement. Frontal fractures occurred in 10 patients (47.6), whereas cerebral contusions were documented in four patients (19). Pneumocephalus represented the most frequent associated injury, observed in 13 patients (61.9). Otorrhea and hemotympanum were each detected in 10 patients (47.6). A significant association emerged between unilateral and bilateral raccoon eyes and fracture location (P < 0.05; P = 0.021), with bilateral presentation more frequently observed in frontal fractures. Conclusion: Several studies have examined basilar skull fractures in moderate to severe traumatic brain injury and have identified raccoon eyes as a common complication. The findings of the present study suggest that raccoon eyes may also serve as a clinical indicator of basilar skull fractures following mTBI and warrant careful evaluation during clinical assessment.