Complications accompanying occipital skull fracture.

One hundred thirty-four cases of occipital skull fracture seen over the past 15 years at the Medical Center Hospital of Vermont have been analyzed with respect to their clinical course and neurologic outcome. Among the cases reviewed, one third of patients had an uncomplicated course, 24% recovered with mild neurologic findings (such as cranial nerve palsy), and 13% died as a result of neurologic insult. This high morbidity results from combinations of traumatic subarachnoid hemorrhage, coup and contrecoup brain lesions, and injury at the skull base. Posterior fossa hematoma, cerebellar contusion, parietal and occipital lobe injury, and cranial nerve injuries associated with this lesion are discussed in detail. CAT scanning is now part of our diagnostic routine in patients with occipital fracture in coma grades 1-5 (Grady scale).