Battle's sign

Raccoon eyes may be accompanied by Battle's sign, an ecchymosis behind the ear.

Battle's sign - is ecchymosis of the mastoid process of the temporal bone.

Battle's sign may be confused with a spreading hematoma from a fracture of the mandibular condyle, which is a less serious injury.

Battle's sign consists of bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery.

In medical terminology, Battle's sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.

Basilar skull fractures, those that occur at the base of the skull, are associated with Battle's sign, a subcutaneous bleed over the mastoid, hemotympanum, and cerebrospinal fluid rhinorrhea and otorrhea.

The hematoma may spread downwards and backwards behind the ear, which may be confused with Battle's sign (a sign of a base of skull fracture), although this is an uncommon finding so if present, intra-cranial injury must be ruled out.

Insertion of an NPA is contraindicated in patients with severe head or facial injuries, or have evidence of a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct intrusion upon brain tissue.