Differential Diagnosis for 17-Month-Old with Head Injury
- Single Most Likely Diagnosis
- Basilar skull fracture: The presence of blood in the right ear canal after a head injury is highly suggestive of a basilar skull fracture. The fact that the CT head shows no acute intracranial abnormalities does not rule out this diagnosis, as basilar skull fractures can be subtle and may not always be visible on initial CT scans.
- Other Likely Diagnoses
- Otitic hemorrhage: Given the patient has tubes and presented with blood in the ear canal, otitic hemorrhage (bleeding from the ear due to an infection or trauma) is a possible diagnosis. However, the context of a head injury makes basilar skull fracture more likely.
- Traumatic tympanic membrane perforation: The blood in the ear canal could also be due to a perforated eardrum from the trauma, which is a common injury in such scenarios.
- Do Not Miss Diagnoses
- Intracranial hemorrhage or other intracranial injuries not visible on initial CT: Although the CT head shows no acute intracranial abnormalities, it is crucial not to miss potential intracranial injuries that might not be immediately apparent. Repeat imaging or close observation may be necessary.
- Non-accidental trauma (child abuse): Given the mechanism of injury (dropped by a parent), it is essential to consider the possibility of non-accidental trauma. A thorough investigation into the circumstances of the injury and the patient's home environment is necessary.
- Rare Diagnoses
- CSF otorrhea: This is a rare condition where cerebrospinal fluid leaks into the ear canal, which could be a complication of a basilar skull fracture. It might not be immediately apparent and requires a high index of suspicion.
- Perilymphatic fistula: Another rare condition that could result from trauma, leading to an abnormal connection between the inner and middle ear, causing hearing and balance problems.