What should be suspected in a patient with signs of severe head injury accompanied by clear fluid draining from the ear?

When a patient presents with signs of a severe head injury and clear fluid draining from the ear, the most likely condition to suspect is a basilar skull fracture. This type of fracture often results in the tearing of the membranes surrounding the brain, which can cause cerebrospinal fluid (CSF) to leak. The clear fluid that drains from the ear is indicative of this possible CSF leak.

In cases of basilar skull fractures, the drainage can also occur from the nasal cavity or through the nose, referred to as rhinoliquorrhea, in addition to the ear drainage. The presence of clear fluid and the context of a head injury provide strong evidence for this type of fracture as it suggests a breach in the barriers that normally protect the CSF.

While skull fractures can be generalized, they do not specifically indicate the severity or location that would lead to such CSF leakage. Intracranial hemorrhage and cerebral edema are also serious complications following head injuries, but they do not typically present with clear fluid drainage from the ear. Therefore, the combination of severe head trauma and fluid from the ear clearly aligns with a basilar skull fracture being the most likely cause.