A Battle sign, or Battle’s sign, is a bruise that indicates a fracture at the bottom of the skull. At first, it can look just like a typical bruise that could heal on its own. However, Battle’s sign is a much more serious condition.

The type of fracture that causes Battle’s sign is considered a medical emergency. It can lead to long-term complications. As a rule of thumb, you should call your doctor if you experience any type of head injury.

Keep reading to learn more about the signs and symptoms of Battle’s sign and what you can expect in terms of treatment and outcomes.

Battle’s sign appears as a large bruise that extends across the entire backside of your ear, and it may also extend out to the upper part of your neck.

Sometimes people with Battle’s sign also have “raccoon eyes.” This term refers to bruising around the eyes that’s also related to a skull fracture.

You might also notice a clear fluid draining from your ears and nose. This is caused by a tear in the protective covering of your brain due to the trauma.

Other possible symptoms include:

  • fatigue
  • headaches
  • dizziness
  • blurry vision

Battle’s sign is sometimes mistaken for a common bruise. Bruises occur when blood vessels beneath the skin break from a direct injury. The result is a black and blue spot that can take a few weeks to heal. A typical bruise may get lighter in color or turn yellow or red before completely going away. But unlike a bruise, a Battle’s sign doesn’t fade without any other symptoms.

All skull fractures — including the one that causes Battle’s sign — need immediate medical attention. Call your doctor and explain the circumstances surrounding your head injury, as well as any symptoms you currently have.

The following symptoms require a visit to the emergency room:

  • extreme, sudden fatigue
  • severe headache
  • short-term memory loss
  • slurred speech
  • pale skin
  • changes in behavior
  • constant nausea with vomiting
  • concussion
  • loss of consciousness

It’s important to note that you might not experience any signs or symptoms of Battle’s sign for up to a few days after the initial injury. To be safe, you should call your doctor after you experience any type of significant head injury, even without symptoms.

Signs of concussion in children: When to call the doctor »

Battle’s sign is primarily caused by a type of serious head injury called a basilar skull fracture, or basal fracture. This type of fracture occurs at the base of your skull. Fractures to the base of your skull can occur behind your ears or nasal cavity, as well as near part of your spine.

According to Johns Hopkins Medicine, it’s the most serious and most common type of skull fracture. The danger is from associated injuries to the brain, spinal cord, and blood vessels that run through the skull to feed the brain. Any injury severe enough to fracture the skull could put these other structures at risk.

Skull fractures often occur as the result of a serious injury, fall, or accident. These might include:

  • car accidents
  • sports-related injuries
  • head injuries from not wearing a helmet (such as when bike riding)
  • falls
  • whiplash
  • abuse

If you’ve had a recent head injury, broken nose, or broken cheekbone, a bruise behind the ear might be related to this condition. Unlike typical bruises that form from a direct injury, Battle’s sign isn’t caused from an injury at that location.

A diagnosis for Battle’s sign requires a series of imaging tests to look at your brain. These include:

CT is the most common diagnostic tool used for skull fractures.

Your doctor will need as many details as possible about the head injury. They may also order a blood test.

Learn more about head injuries »

Treating Battle’s sign depends on the severity of the skull fracture that caused it. One main goal of treatment is to prevent permanent neurological damage. You will need to be hospitalized so that your doctor can carefully monitor your condition.

Depending on the type of injury, you may need stitches. Surgery may be needed to stop fluid leakage from your nose and ears.

Overall, this type of skull fracture heals itself. It may take several weeks before you notice an improvement in your symptoms.

Keep reading: How to remove stitches »

Head injuries are a common cause of disability and death. The earlier you seek treatment for a head injury, the better the outlook.

With Battle’s sign, neurological damage is possible. You’ll need to follow up with your doctor on a regular basis after the head injury to make sure your condition doesn’t worsen. Severe damage to the brain may lead to problems with:

  • fine motor skills
  • hearing
  • sense of taste
  • speech
  • vision

Long-term rehabilitation can help. Your healthcare team, including doctors as well as physical and occupational therapists, will work with you to help you make as full of a recovery as possible.