Battle’s sign is a bruise that appears after a person breaks a bone at the base of their skull. This type of break is known as a basilar skull fracture. The bruise might appear behind one or both ears.

Basilar skull fractures can lead to permanent brain injury, meningitis, or other complications.

Minor basilar fractures, however, have a good outlook if the person receives immediate medical care, is carefully observed in hospital, and follows proper aftercare at home.

A bruise behind the ear may be a battle signShare on Pinterest
A Battle’s sign may be an indication of a serious head injury.

Battle’s sign is a crescent-shaped bruise that appears behind one or both ears. It was named after an English surgeon, Dr. William Henry Battle, and can be an indication of a serious head injury.

The skull is made up of more than 20 different bones. The basilar bones at the base of the skull protect the following structures:

  • eyes
  • nerves to the head and neck
  • ears
  • brain stem
  • cerebellum or coordination and balance center

When one of the basilar bones is broken, blood may pool behind the ear, creating the Battle’s sign bruise.

While Battle’s sign may look like an ordinary bruise, it is not a result of direct injury behind the ear. Instead, it is a sign that one or more of the skull’s bones have been broken.

The size of Battle’s sign can vary but may also extend down the back of the neck.

A person with a basilar skull fracture may also have other symptoms in addition to Battle’s sign, including:

  • blood or fluid leaking from ears or nose
  • bruising around the eyes
  • hearing problems
  • loss of sense of smell
  • vision changes
  • weakness in the face from nerve damage
  • fatigue
  • dizziness
  • trouble with coordination
  • headache
  • loss of consciousness
  • nausea and vomiting
  • difficulty speaking
  • memory problems

Battle’s sign may not appear right away. It may take a day or more for the bruise to appear after the skull has been fractured.

Anyone who might have suffered a head injury should seek emergency medical care, even if no bruise is visible.

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Contact sports and physical violence may be causes of Battle’s sign.

Battle’s sign occurs because of a broken bone in the skull, usually after a severe impact to the head. The most common causes of a skull fracture and Battle’s sign include:

  • physical violence
  • contact sports
  • car and motorcycle accidents
  • bicycle accidents without a helmet
  • falls

Wearing proper helmets, using seatbelts, and wearing protective equipment for sports and activities can help reduce the risk of skull fractures.

Any head injury can cause serious complications and become life-threatening. A head injury may result in permanent brain injury, bleeding, and other problems. For this reason, emergency medical care is needed to check any blow to the head.

Some complications of basilar skull fractures include:


Bacterial meningitis is a dangerous infection of the brain and spinal cord that requires emergency medical treatment.

Leakage of brain and spinal fluids occurs in up to 20.8 percent of people with basilar skull fractures. This increases the risk of bacterial meningitis. In fact, up to 40 percent of people with a spinal fluid leak will develop meningitis.

Meningitis may occur after a fracture because bacteria from the nose, ears, and throat can enter the brain or spinal cord if the base of the skull is injured.

Signs of meningitis include:

  • fever
  • stiff neck
  • headache
  • confusion
  • sensitivity to light
  • nausea or vomiting
  • loss of consciousness

A person must seek emergency care after a head injury, especially if any of these symptoms appear, as meningitis is life-threatening.

Although meningitis is treated with antibiotics, experts say that giving antibiotics after all basilar skull fractures may not be helpful.

One study found that there is not enough evidence to support giving people antibiotics for basilar skull fractures alone.

Another review also states that using antibiotics to prevent meningitis after a basilar skull fracture does not improve outcomes. The researchers conclude that antibiotics should only be given if the person has meningitis.

Blood vessel injury

Basilar skull fractures can also cause injuries to the blood vessels that supply the brain. These are called cerebrovascular injuries.

People with basilar skull fractures are at high risk of having a cerebrovascular injury. This type of injury can cause permanent brain damage or death.

Therefore, people with possible basilar skull fractures should undergo a computed tomography (CT) scan to check for this complication.

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It is recommended to seek immediate medical care with Battle’s sign.

Battle’s sign means a person should seek medical care immediately. But, the appearance of this bruise is not enough to determine what treatment is needed. A doctor will need to evaluate a person’s neurological health as well.

Some tests that a person may receive include:

  • CT scan
  • magnetic resonance imaging or MRI
  • electroencephalography or EEG
  • X-ray
  • physical exam
  • blood tests

These tests can show whether the brain is injured and the extent of injury to help the doctor decide on a treatment plan. They can also reveal whether the broken bones have moved.

In severe cases, surgery may be needed to treat broken bones, brain injuries, or brain and spinal fluid leaks.

Not all of these tests may be required after minor head injuries, depending on the person’s age, underlying health problems, and any medications they are taking.

Usually, younger children who have no symptoms of neurological problems recover well after minor head injuries.

However, all head injuries need to be evaluated by a doctor to rule out skull fractures, brain injuries, and other complications.

If there are no signs of brain injury, bleeding, or other complications, careful observation by a doctor and home care may be adequate treatment for some minor basilar skull fractures.

Children with basilar skull fractures could be released from the hospital to recover at home if they:

  • have no neurological issues as determined by doctors
  • show no brain damage on a CT scan
  • have no broken bones that are out of place
  • have no leakage of brain and spinal fluids

Though many basilar skull fractures do heal on their own, diligent aftercare at home is needed. Once a person has received proper medical treatment and been discharged, they should:

  • Take care to not injure their head again while it is healing. This includes avoiding certain sports and physical activities for several months.
  • Ensure they attend all follow-up appointments.
  • Watch carefully for any symptoms of meningitis, such as fever, stiff neck, or headache, and seek emergency care if these appear.
  • See a doctor right away for new symptoms, such as worsening headache, dizziness, confusion, or loss of consciousness.

Basilar skull fractures can range from minor to severe. Even if a person’s symptoms are mild, Battle’s sign should never be ignored. Only a doctor can determine what medical care is needed after a head injury.

Any head injury, including those with Battle’s sign, is an indication that a person should seek emergency care.

Fortunately, many basilar skull fractures heal well after a person receives medical treatment.