Final answer:
A patient with dilated pupil, respiratory distress, and coma after a skull fracture may have a contrecoup fracture of the basilar portion of the occipital bone, potentially causing serious brain injury due to arterial damage.
Step-by-step explanation:
The patient's dilated pupil, respiratory distress, and comatose state after a skull fracture could be indicative of a severe brain injury. A blow to the head can cause a contrecoup fracture, which is particularly dangerous when it involves the basilar portion of the occipital bone. This type of fracture can lead to life-threatening complications because it can damage the artery that runs through the carotid canal, leading to intracranial bleeding and brain damage.