Battle's sign is bruising over the mastoid process that usually appears 24-48 hours after blunt head trauma. Its presence is highly predictive of a basilar skull fracture-especially of the temporal bone or middle cranial fossa-but it is not pathognomonic. Other injuries (e.g., mandibular condyle fracture) or rare medical conditions can also produce similar bruising, and many basilar skull fractures occur without Battle's sign. Therefore, clinicians should use the sign as a cue to obtain imaging and perform a full neurologic evaluation rather than as definitive proof or exclusion of a skull-base fracture.
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