Differential Diagnosis for 90y Male Post Head Injury
Single Most Likely Diagnosis
- Post-concussive syndrome: The patient's report of "abnormal head sensations" after a head injury, combined with the presence of atrophy on MRI, suggests a possible diagnosis of post-concussive syndrome, which is a common condition after head trauma in the elderly.
Other Likely Diagnoses
- Chronic subdural hematoma: Given the patient's age and history of head injury, a chronic subdural hematoma is a possible diagnosis, although the MRI findings do not specifically mention this condition.
- Sinusitis-related headache: The presence of chronic and acute left maxillary sinusitis, as well as right mastoid sinus effusion, could be contributing to the patient's "abnormal head sensations", which may be perceived as headaches or facial pain.
- Cerebral small vessel disease: The MRI finding of atrophy associated with microangiopathy is consistent with cerebral small vessel disease, which is a common condition in the elderly and can cause a variety of symptoms, including cognitive decline and gait disturbances.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less likely given the patient's stable presentation, a subarachnoid hemorrhage is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Meningitis: The presence of sinusitis and mastoid sinus effusion increases the risk of meningitis, which is a medical emergency that requires prompt diagnosis and treatment.
- Brain tumor: Although rare, a brain tumor could be causing the patient's symptoms, and a thorough evaluation is necessary to rule out this possibility.
Rare Diagnoses
- Giant cell arteritis: This condition is rare in the elderly, but can cause headaches and "abnormal head sensations", and is associated with an increased risk of vision loss if left untreated.
- Cerebral amyloid angiopathy: This condition is characterized by the deposition of amyloid beta in the blood vessels of the brain and can cause a variety of symptoms, including headaches and cognitive decline.
- Neurosyphilis: This condition is rare, but can cause a variety of symptoms, including headaches, cognitive decline, and personality changes, and is associated with an increased risk of stroke and other complications if left untreated.