Differential Diagnosis
- Single most likely diagnosis
- Chronic subdural haematoma: This is the most likely diagnosis given the patient's history of a fall two weeks prior to presentation, with gradual onset of symptoms such as general weakness and inability to stand or walk, without loss of consciousness or severe headache. The CT image showing two hypodense brain lesions also supports this diagnosis, as chronic subdural hematomas often appear hypodense due to the breakdown of blood products over time.
- Other Likely diagnoses
- Subacute subdural haematoma: This could be considered if the symptoms had developed sooner after the fall, but the two-week timeframe still makes it a possibility. However, the lack of severe symptoms initially and the gradual onset make chronic subdural hematoma more likely.
- Acute subdural haematoma: Less likely given the timeframe and the nature of the symptoms. Acute subdural hematomas typically present immediately after a traumatic event with severe symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Extradural haemorrhage (Extradural hematoma): Although less likely given the timeframe and the description of the CT findings, an extradural hematoma can be life-threatening and requires immediate intervention. It's crucial to consider this diagnosis, especially if there's any suspicion of a significant head injury.
- Rare diagnoses
- Other intracranial pathologies (e.g., tumors, abscesses, or cysts): While rare, these conditions could potentially present with similar symptoms and hypodense lesions on CT. However, the history of a recent fall makes a traumatic cause more likely.
- Infectious or inflammatory conditions: Conditions such as encephalitis or meningitis could present with weakness and altered mental status but would typically have additional symptoms such as fever, headache, or stiff neck, and different findings on imaging.