Brief reportThe ‘Ring Sign’: Is it a reliable indicator for cerebral spinal fluid?
References (7)
Head and neck trauma
Diagnosis and treatment of head injury in infants and children
Cited by (24)
An unusual case of otorrhagia
2012, Journal of Emergency MedicineCitation Excerpt :However, as demonstrated by this case, a history of trauma and the presence of otorrhagia do not always correlate with a basilar skull fracture diagnosis. Even the hallowed “halo” or “ring” sign does not cinch the diagnosis because other fluids mixed with blood will form a “halo” as well (8,9). According to the consulting oromaxillofacial and neurosurgical colleagues, the blood-tinged fluid flowing from our patient's ears was due to a cochlear otolymph/blood mixture.
Fracture of the external auditory canal mimicking basilar skull fracture
2012, Journal of Emergency MedicineCitation Excerpt :When there is doubt about the origin of the blood, the diagnosis of a basilar skull fracture must be excluded. Distinguishing blood due to a basilar skull fracture from cutaneous bleeding using the “halo sign” (applying a drop of blood to a filter paper looking for more rapidly diffusing cerebrospinal fluid surrounding the blood), is often cited but unreliable (3–5). In this patient, based on the history of direct mandibular impact, mandibular trauma with EAC fractures was presumed to be the cause of bleeding.
Halo Sign Is Neither Sensitive Nor Specific For Cerebrospinal Fluid Leak
2009, Annals of Emergency MedicineBasal skull fracture and the halo sign
2013, CMAJ. Canadian Medical Association JournalManagement of the Postoperative Leak
2023, Skull Base Reconstruction: Management of Cerebrospinal Fluid Leaks and Skull Base Defects