drainage of CSF into paranasal sinuses and rhinorrhea Anterior venous sinus drainage may cause blood leakage into the periorbital tissues (raccoon eyes) Given the location of basilar skull fractures, associated cranial nerve palsies may occur There is a high incidence of associated TBI in children with basilar skull fracture, even in those with a Glasgow Coma Scale (GCS) score of 15 and normal neurologic examination results Of note, not all basilar skull fractures are evident on computed tomography (CT); however, a patient with classic clinical signs should be considered to have this fracture even without demonstrable fracture on CT Traumatic Brain Injury Insults to intracranial contents include functional derangements without demonstrable lesions on CT scan (concussion, posttraumatic seizures) as well as structural changes such as hemorrhage (cerebral contusion, epidural hematoma [EDH], subdural hematoma [SDH], subarachnoid hemorrhage, and intracerebral hemorrhage), and cerebral edema Depending on the proximity of imaging to the injury event, some structural changes (such as diffuse axonal injury) may not be initially evident on CT scan though such lesions would likely be apparent on Magnetic Resonance Imaging (MRI) MRI also demonstrates greater sensitivity in detecting microhemorrhages though the clinical significance of these lesions is controversial Rarely, penetrating brain injuries occur in children TBIs may also be classified as focal (e.g., contusions, hematomas, lacerations) or diffuse (e.g., diffuse axonal injury with cerebral edema) Focal injuries are usually apparent on the initial CT scan, even if clinically asymptomatic Diffuse injuries, in contrast, may not demonstrate striking abnormalities on early CT imaging, even if the patient manifests significant alteration in neurologic function Since some small intracranial abnormalities noted on advanced imaging are of unclear significance (those that require neither clinical intervention nor prolonged hospitalization), clinically important traumatic brain injury (ciTBI) has been defined as brain injury that causes death or requires neurosurgical intervention, intubation, or hospital admission for at least two nights Concussion Concussion is typically a minor brain injury characterized by posttraumatic alteration in mental status that may or may not involve loss of consciousness (LOC) No consistent associated pathologic lesion has been identified on neuroimaging The child may have a depressed level of consciousness, pallor, vomiting, amnesia, and confusion The clinical picture often normalizes within