Differential Diagnosis for 17-Month-Old with Head Injury
- Single Most Likely Diagnosis
- Basilar skull fracture: The presence of blood in the ear canal and the history of head injury make this a likely diagnosis, especially given the patient's age and mechanism of injury. The fact that the patient has tubes (tympanostomy tubes) and presents with sinus drainage and congestion could be related to the injury or a pre-existing condition.
- Other Likely Diagnoses
- Otitis media or externa: Given the patient's history of having tubes and the presence of sinus drainage and congestion, an ear infection could be a contributing factor to the patient's presentation.
- Concussion or minor traumatic brain injury: Although the CT head shows no acute intracranial abnormalities, the patient could still have suffered a concussion, which might not be immediately apparent on imaging.
- Do Not Miss Diagnoses
- Intracranial hemorrhage or other intracranial injuries not visible on initial CT: Although the initial CT head is negative, it's crucial to consider the possibility of an evolving injury, especially in young children whose brains are more susceptible to injury.
- Meningitis: The presence of sinus drainage and congestion, along with a head injury, could potentially lead to meningitis, especially if there's a breach in the dura mater.
- Child abuse: Given the mechanism of injury (being dropped by a parent), it's essential to consider non-accidental trauma as a potential cause, ensuring the safety of the child.
- Rare Diagnoses
- CSF leak: Although less common, a basilar skull fracture could potentially lead to a cerebrospinal fluid (CSF) leak, which might not be immediately apparent.
- Perilymphatic fistula: This is a rare condition that could occur after head trauma, leading to symptoms related to the middle and inner ear.