The evaluation of a skull fracture begins with a history and physical exam.

Physical findings in someone with a skull fracture may include:

• Scalp swelling
• Scalp contusion
• Skin wound to the scalp:
• Scalp abrasion
• Scalp laceration
• Scalp puncture wound
• Deformed skull:
• A depressed area, or indentation in the skull
• Visible skull fracture through a scalp wound
• Neck tenderness

Additional physical findings may be present in someone with a fracture to the base of the skull, called a basilar skull fracture.

Physical findings in someone with a basilar skull fracture include:

• Blood behind the eardrum
• Bruising behind the ear (Battle sign)
• Bruising around both eyes
• Clear fluid leaking from the nose

Additional findings in someone with a brain injury may include:

• Abnormal eye muscle exam
• Abnormal eye pupil exam
• Arm numbness (unilateral)
• Leg numbness (unilateral)
• Arm and leg numbness (unilateral)
• Arm weakness (unilateral)
• Leg weakness (unilateral)
• Arm and leg weakness (unilateral)
• Difficulty speaking
• Difficulty walking
• Loss of consciousness
• Papilledema:
• Evidence of increased brain pressure on eye exam
• Memory loss
• Confusion
• Seizure
• Coma

Testing may be necessary to determine the extent of the injury.

Tests that may be used to evaluate a skull fracture include:

• Skull x-rays
• CT scan of the brain
• MRI scan of the brain
• X-rays of the neck:
• Normal cervical spine
• Torn ligaments
• Fracture of the odontoid process of the second vertebra
• Fracture of a vertebral body
• Fracture of a spinous process in the back of a neck vertebra