MRI may be useful in assessing nerve injury and in evaluating for a cerebrospinal fluid leak. Further imaging with CT angiography and venography (CTA, CTV) to assess for vascular injury should be considered in the acute setting. Pneumocephalus should raise the suspicion for a basilar skull fracture. Conversely, the detailed small neural and vascular channels visualized on MDCT may be misread as fractures. In patients where a high clinical suspicion for basilar skull fracture exists, multidetector CT (MDCT) thin-slice scanning through the face and skull base may aid in the detection of more subtle fractures. Unfortunately, skull-based fractures that are linear or non-displaced may be difficult to detect. The initial evaluation is usually via a non-contrast computed tomography (CT) scan. Plain x-rays are not sensitive to detect basilar skull fracture. The diagnosis may be obvious on a physical exam in some cases.
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