Neurosurgery 1-

Questions that can be asked in Super Specialty  Entrance exams in Neurosurgery

Q1) Racoon Sign is seen in 

a) Head injury

b) Sub galeal haematoma

c) Sub conjunctival haemorrhage

d) Nasal bone fracture

Q2. Which is not a sign in fracture of base of skull

a) Battle's sign

b) Racoon's eyes or Panda eyes

c) CSF otorrhoea

d) Subconjunctival haemorrhage

Q3) True about Le fort's fracture

a) Type I is pyramidal in shape

b) Type II involves the orbit and fractures the cribriform plate

c) Type III separates the facial alveolus from facial skeleton above it

d) CSF and dural leaks are more common in type II fractures


Q4. Previously healthy 72 year old male has become "senile" over the past few days. Now he has a vacant stare, does not speak and sleeps a lot. His wife says that he had a fall in the bathroom 10 days back. What is the diagnosis ?

a) Alzheimer's

b) Acute Subdural haematoma

c) Epidural haematoma

d) ChronicSubdural haematoma



1 b

Racoon eye or panda sign is periorbital ecchymosis that is seen in base of skull fracture. It is also seen in subgaleal haematoma, meningeal rupture and some cancers.  The blood seeps from base of skull and collects around the loose areolar tissue around the eyes.

Base of Skull Fractures  are often missed on CT and plain skull x-rays. Clinical signs are usually more sensitive.

Signs of BSF may take several hours to develop and include cerebrospinal fluid (CSF), otorrhea or rhinorrhea, hemotympanum, laceration of the external auditory canal, postauricular ecchymosis (Battle’s sign) and periorbital ecchymosis with tarsal plate sparing (Raccoon eyes). Battle’s sign and unilateral blepharohematoma have the highest predictive value. Tarsal plate sparing is due to an anatomic structure called the orbital septum, which limits extravasation of blood beyond the tarsal plate . Indirect radiographic findings that suggest BSF include pneumocephalus and air-fluid levels within, or opacification of, an air sinus.


 2. d

Its not subconjunctival haemorrhage, its periorbital.

As explained above the signs of Base of Skull fracture are - 

 Battle’s sign (bruising over the mastoid)

Racoon’ or ‘panda’ eyes (bilateral periorbital bruising).

Haemotympanum, or overt bleeding from the ear if the tympanic membrane has ruptured, and CSF rhinorrhoea or otorrhoea 

3. b

Le fort classification is for fractures of the middle 1/3 of facial skeleton. It is a very old classification system which was demonstrated on cadavers.

Le fort
Le fort

Type I 

Separates the alveolus and palate from facial skeleton above it.

Type II

Pyramidal in shape

Fractures cribriform plate involves bridge of nose and ethmoids


Fracture line runs through nasal bride, ethmoids and goes to frontozygomatic suture. CSF And dural leaks are more common in this type

4. d

This is a case of chronic subdural haematoma

These patients are elderly, mostly on antiplatelets with recent history of fall. Mass effect is produced over a period of days to weeks.


  1. Pressure symptoms
  2. Seizures
  3. Neurological deficit

Acute subdural haematoma is associated with forceful and high impact head injuries. Conscious level is altered right from the begining

Extra dural haematoma has contralateral hemiparesis, ipsilateral pupillary dilatation and altered conscious levels


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