Differential Diagnosis for 17-Month-Old with Head Injury
- Single Most Likely Diagnosis
- Basilar skull fracture: The presence of blood in the 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, it's possible that the blood is coming from the ear itself, possibly due to trauma to the ear or an infection.
- Cerebral concussion: Although the patient is alert and active, a concussion is still a possibility, especially given the mechanism of injury. The absence of acute intracranial abnormalities on CT does not exclude this diagnosis.
- Do Not Miss Diagnoses
- Epidural or subdural hematoma: Although the CT head shows no acute intracranial abnormalities, it's crucial to consider the possibility of an evolving hematoma, especially if the patient's condition changes or if there are any signs of increased intracranial pressure.
- Child abuse: The history of being dropped by a parent raises concerns about potential non-accidental trauma. It's essential to consider this possibility and investigate further if there are any inconsistencies in the history or if there are other signs of abuse.
- Rare Diagnoses
- CSF otorrhea: A basilar skull fracture can lead to a communication between the subarachnoid space and the ear, resulting in cerebrospinal fluid (CSF) leaking into the ear canal. This is a rare but potentially serious complication.
- Perilymphatic fistula: Trauma to the ear can cause a fistula (abnormal connection) between the inner and middle ear, leading to symptoms such as hearing loss, vertigo, and tinnitus. This is a rare diagnosis but should be considered in the context of head trauma and ear symptoms.