Raccoon eye after basilar skull fractures from mild traumatic brain injury

Mild traumatic brain injury is highly prevalent; however, accurate diagnosis, standardized criteria, and clinical outcome assessment remain challenging. This study aimed to determine the frequency of raccoon eyes in patients with basilar skull fractures following mTBI This single-center study included patients with basilar skull fractures following mild traumatic brain injury who were admitted to Al-Zahra Hospital between February 2024 and February 2025. A census sampling approach was used, and 21 patients were enrolled, with raccoon eyes assessed in each. Among 120 patients with basilar skull fractures following mTBI, 21 (17.5%) developed raccoon eyes, including 11 cases (52.4%) with unilateral presentation and 10 cases (47.6%) with bilateral involvement. Frontal fractures occurred in 10 patients (47.6%), whereas cerebral contusions were documented in four patients (19%). Pneumocephalus represented the most frequent associated injury, observed in 13 patients (61.9%). Otorrhea and hemotympanum were each detected in 10 patients (47.6%). A significant association emerged between unilateral and bilateral raccoon eyes and fracture location (P < 0.05; P = 0.021), with bilateral presentation more frequently observed in frontal fractures. Several studies have examined basilar skull fractures in moderate to severe traumatic brain injury and have identified raccoon eyes as a common complication. The findings of the present study suggest that raccoon eyes may also serve as a clinical indicator of basilar skull fractures following mTBI and warrant careful evaluation during clinical assessment.