Battle’s symptom

Battle’s symptom is a classic clinical sign indicating a skull base fracture. It is characterised by the appearance of bruising (hematoma) in the retro-auricular region, above the mastoid region of the temporal bone.

This symptom does not appear immediately after the injury, but develops within 24–48 hours. The delay is due to the fact that blood from the fracture site in the skull slowly leaks under the skin in the area behind the ear.

Aetiology and pathophysiology

Battle’s symptom is a consequence of a fracture of the temporal bone pyramid, which is part of the base of the skull. This type of fracture causes small blood vessels to rupture, and blood from the posterior cranial fossa enters the cells of the mastoid region and then under the skin.

Clinical Significance

The appearance of Battle’s symptom is an important diagnostic marker of severe traumatic brain injury. Although it is not immediately visible, its detection during visual inspection of a patient with head trauma requires immediate and thorough examination.

The presence of this sign is highly specific for a skull base fracture and is a direct indication for computed tomography (CT) of the brain and skull bones to confirm the diagnosis. It is often associated with other signs, such as “spectacle sign” (periorbital hematoma) and cerebrospinal fluid (CSF) leakage from the ear or nose.