Question 124

Question:

A 27 year-old woman is brought to the emergency room by ambulance after a car accident. She is complaining of a severe headache and is somewhat disoriented. Her heart rate is 110 and her blood pressure is 134/72. She has several abrasions of her face with some swelling and ecchymosis. She has a dark ecchymosis over her right mastoid process. CT scan of the head shows an intracranial hemorrhage that does not cross suture lines. The anatomic structure that passes through which of the following foramina has most likely been damaged?

Correct Answer: D.  Foramen spinosum

This patient has a basilar skull fracture secondary to trauma sustained in a car accident. Battle’s sign, ecchymosis over the mastoid process, is consistent with a basilar skull fracture. Also, this patient has an epidural hemorrhage as seen on CT scan (does not cross suture lines). This scenario is due to rupture of the middle meningeal artery, which passes through the foramen spinosum. The maxillary nerve (V2) passes through the foramen rotundum. The optic nerve and ophthalmic artery passes through the optic canal. The internal carotid artery passes through the carotid canal. The brainstem (specifically, the medulla), meninges, vertebral arteries, and the spinal roots of the accessory nerve all pass through the foramen magnum.