What is Battle's Sign?

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  • Written By: F. Hay
  • Edited By: R. Halprin
  • Last Modified Date: 28 August 2018
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Named after a British doctor, Battle’s sign — also known as mastoid ecchymosis — is a physical sign of trauma to the head that might be suggestive of brain trauma. Ecchymosis is bruising which appears on the surface of the skin and is caused by the escape of blood into the tissues from ruptured blood vessels. Battle’s sign bruising appears behind one or both ears and is one indication of a basilar skull fracture caused by acute trauma to the head. Battle’s sign will normally develop within 24 to 36 hours after head trauma and might be visible for several weeks. A blow to the head strong enough to produce Battle’s sign could cause injury to the cranial nerves, brain stem, and lead to intracranial hemorrhage and even death.

Battle’s sign is named after Dr. William Henry Battle, an English surgeon who studied head injury cases involving concussions and optic neuritis, which is an inflammation to the eye. His studies led him to discover that the physical sign of bruising behind the ear to be indicative of a basilar skull fracture. Although Battle’s sign is an indicator of head trauma, other physical signs and neurologic symptoms are taken into consideration to evaluate and properly diagnose a skull fracture.


When physical or neurologic signs of a skull fracture are found upon physical examination by a physician, an x-ray or topography scan is often ordered to diagnose the severity of the head injury. Once the severity of the skull fracture is assessed, a plan of treatment is determined. If the skull fracture is not severe, then bed rest for several days to a few weeks is frequently recommended. A more severe head injury might require a surgical procedure, known as a craniotomy, to remove blood clots formed in the brain.

Motor vehicle or bicycle accidents, falls, severe blows to the head, or physical abuse are some of the leading causes of skull fractures resulting in the appearance of Battle’s sign. Other physical signs of head trauma are leaking of cerebrospinal fluid (CSF) from the ears or nose, the appearance of a purplish discoloration surrounding the skin around the eyes called raccoon eyes, or differing size of pupils. Doctors check for all of these symptoms to determine if a traumatic injury to the skull or brain has occurred. Slurred speech, disorientation, and decreased alertness could be signs of a skull fracture or brain injury. A head injury accompanied by Battle’s sign might be life threatening and suggestive of underlying brain trauma and should immediately be checked by a physician.


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Post 2

Head injuries are nothing to mess around with. I wonder how many NFL players have had Battle's sign a day or two after a hard hit and the team doctors just ignored it? Or they put the player on bed rest and never had him follow up with a neurologist. I don't see how those people sleep at night.

I have heard of people leaking CNS fluid out of their ears and noses, but had never heard of Battle's sign, per se.

Post 1

A friend's son had a wreck on a four-wheeler and suffered a basilar skull fracture. When the EMTs got to the scene, my friend said her son had CNS fluid leaking from his ears. They were very, very concerned about him.

Fortunately, we do have a Level 1 Trauma Center within easy chopper distance, so he was able to get very good treatment, very quickly.

He does have some memory loss and double vision, but he's improving all the time.

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