A skull fracture doesn’t always look dramatic from the outside. The most common type, a linear fracture, is a thin crack in the bone that produces no visible deformity at all. You might see only swelling, tenderness, or a bruise at the impact site. Other types, like depressed fractures, create a visible or palpable dent in the skull. What a skull fracture looks like depends entirely on which bones broke, how they broke, and where the bleeding tracks afterward.
External Signs You Can See or Feel
The simplest skull fractures produce surprisingly little to see. A linear fracture, the most common kind, often looks like nothing more than a swollen, tender area on the head. The bone cracks in a straight line but stays in place, so the shape of the skull appears normal. Without a CT scan, even emergency physicians can miss these.
A depressed fracture is different. Part of the skull gets pushed inward toward the brain, creating a visible or tactile indentation at the injury site. It can involve multiple bone fragments, and the area may feel sunken compared to the surrounding skull. Sometimes there’s a scalp wound over the depression, and sometimes the skin stays intact, making the sunken bone harder to spot under swelling. This is the type most people picture when they imagine a skull fracture.
An open (compound) fracture breaks through the skin. You’ll see a scalp laceration with bone fragments visible or protruding from the wound. These carry a high risk of infection because the brain’s protective layers are exposed.
Bruising Patterns That Signal a Base-of-Skull Fracture
Fractures at the base of the skull, where the skull meets the spine, produce some of the most distinctive visible signs. These don’t always show up immediately. Blood from the fracture site tracks slowly through tissue, and the resulting bruising can take hours to a full day or more to appear.
“Raccoon eyes” refers to dark bruising that develops around one or both eye sockets. The discoloration spreads across the eyelids and surrounding skin, looking much like a black eye but appearing without a direct blow to the face. It results from blood pooling forward from a fracture in the front or middle portion of the skull base.
Battle’s sign is bruising behind the ear, specifically over the bony bump (the mastoid) behind the earlobe. It appears as a purple or bluish discoloration on the skin behind the ear. Like raccoon eyes, it takes time to develop and signals a fracture running through the base of the skull near the ear.
Either sign on its own is a strong indicator of a basilar skull fracture, even when the person seems otherwise alert.
Clear Fluid From the Nose or Ears
One of the most telling signs of a skull base fracture is clear, watery fluid draining from one side of the nose or from an ear. This is cerebrospinal fluid (the liquid that cushions the brain) leaking through a tear in the membranes caused by the fracture. It looks like thin, watery discharge, not thick like mucus or yellow like pus. It typically drains from one side only.
If blood mixes with the cerebrospinal fluid, you may notice a “halo sign” on a pillowcase or bandage: a central spot of blood surrounded by a lighter ring of clear fluid. This pattern happens because the two fluids separate as they soak into fabric.
How It Looks on a CT Scan
Most skull fractures are confirmed with a CT scan, not by physical exam alone. What doctors see on imaging varies by fracture type.
- Linear fractures appear as a thin dark line running through the bone. They can be easy to confuse with normal skull sutures (the natural seams between skull bones), so radiologists look at the line’s location and pattern to tell them apart.
- Depressed fractures show up as bone segments pushed below the level of the surrounding skull. On a CT scan, you can clearly see the inward displacement, and any associated bone fragments or bleeding near the brain surface. A curvilinear shadow on a plain X-ray can also suggest a depressed fracture.
- Diastatic fractures widen the natural suture lines between skull bones. On serial imaging, these can evolve from a small gap into a larger defect over time, particularly in children.
- Comminuted fractures show the bone shattered into multiple fragments. CT imaging reveals the fragments’ positions relative to the brain and can detect clotted blood along the brain’s surface.
CT scans also reveal complications that aren’t visible from the outside, like bleeding between the skull and brain or swelling of brain tissue beneath the fracture.
Skull Fracture vs. a “Goose Egg”
After a head impact, a raised, firm lump (often called a goose egg) is common. This is a scalp hematoma, a collection of blood under the skin, and it’s usually harmless. The key difference: a goose egg pushes outward. The bump is raised above the surrounding skull surface. A depressed skull fracture does the opposite. The injured area feels sunken or flat compared to the bone around it, even if there’s swelling on top.
A large, tense swelling that keeps growing, or a soft boggy area rather than a firm bump, deserves closer attention. These patterns can suggest bleeding beneath the skull’s outer layer rather than just a superficial bruise.
What to Look For in Infants
Infant skulls are thinner and more flexible than adult skulls, which changes how fractures present. The fontanelles (soft spots) on a baby’s head are useful indicators. A bulging or swollen soft spot after a fall can signal head trauma, including a skull fracture or increased pressure inside the skull. In infants, raccoon eyes and Battle’s sign carry the same meaning as in adults and should be treated as red flags for a basilar fracture.
A specific type of infant skull fracture, sometimes called a “ping-pong fracture,” creates a smooth inward dent in the skull that looks like pressing a finger into a ping-pong ball. There’s no sharp break, just a buckled depression, because the infant’s bone is still soft enough to bend rather than crack cleanly.
Neurological Signs That Accompany the Injury
Beyond what the fracture itself looks like, certain visible neurological changes point to a more serious injury underneath. Unequal pupil sizes (one pupil noticeably larger than the other) suggest pressure building on one side of the brain. Bruising around both eyes combined with confusion or vomiting raises concern for significant intracranial injury. Blood pooling visibly in the white of the eye without a direct eye injury can also accompany skull base fractures.
Loss of consciousness, repeated vomiting, worsening headache, and increasing drowsiness aren’t “visible” in the same way as bruising, but they’re the behavioral signs most commonly paired with fractures that need urgent treatment. A person who looks fine externally but acts increasingly confused after a head injury needs imaging regardless of what the outside of their head looks like.