Differential Diagnosis for TBI with Right Upward Fixed Gaze and Seizures
Single Most Likely Diagnosis
- Traumatic Brain Injury with Third Cranial Nerve Palsy: The right upward fixed gaze suggests an injury to the third cranial nerve, which controls eye movement. This, combined with a history of blunt trauma and seizures, points towards a significant traumatic brain injury.
Other Likely Diagnoses
- Epidural Hematoma: A type of bleeding in the brain that can cause increased intracranial pressure, leading to symptoms like fixed gaze and seizures, especially after a blunt head injury.
- Subdural Hematoma: Similar to an epidural hematoma but located beneath the dura mater, it can also cause increased intracranial pressure and neurological deficits.
- Cerebral Edema: Swelling of the brain tissue after a traumatic injury, which can lead to increased intracranial pressure, seizures, and focal neurological signs like abnormal gaze.
Do Not Miss Diagnoses
- Ruptured Aneurysm: Although less likely given the blunt trauma context, a ruptured aneurysm can cause sudden onset of symptoms including seizures and fixed gaze due to bleeding into the subarachnoid space.
- Intracranial Infection (e.g., Abscess): Post-traumatic infections can lead to seizures, focal neurological deficits, and increased intracranial pressure, making them critical to rule out.
- Cerebral Venous Sinus Thrombosis: A blood clot in the venous sinuses of the brain, which can cause seizures, increased intracranial pressure, and focal neurological signs.
Rare Diagnoses
- Traumatic Arteriovenous Fistula: An abnormal connection between arteries and veins that can occur after trauma, potentially leading to neurological symptoms due to altered blood flow.
- Colloid Cyst: A rare type of brain tumor that can cause obstructive hydrocephalus, leading to increased intracranial pressure, seizures, and potentially abnormal gaze if it affects brainstem structures.
- Pineal Region Tumors: Tumors in this area can cause Parinaud's syndrome (dorsal midbrain syndrome), characterized by upward gaze palsy, among other symptoms, but are less likely in the acute setting of a blunt injury.