What does halo sign indicate?

• A. Blood from the ears
• B. Clear drainage from the nose
• C. Cerebrospinal fluid coming from the ears
• D. Pus in the dressing

Answer: (C)

Halo sign means cerebrospinal fluid is present in the drainage, indicating a CSF leak, usually from a skull base fracture. On a dressing, CSF mixed with blood can create a clear ring around the blood—a halo—signaling that the fluid is CSF rather than just blood. This is most often described with CSF draining from the ear (CSF otorrhea) but can occur with nasal drainage as well (CSF rhinorrhea). Recognize this as a high-risk finding for intracranial injury and possible meningitis, and transport urgently. Do not insert anything into the ear or nose and provide supportive care (positioning, oxygen as needed) while monitoring the patient.