Differential Diagnosis for the 47-year-old Woman with Left-Sided Headache
Single Most Likely Diagnosis
- D) Middle meningeal artery: The patient's history of a motor vehicle collision, hitting her head on the window, and developing a bump later on the left side of her head, followed by a worsening left-sided headache that is worse with physical activity and when lying down, suggests a possible epidural hematoma due to injury of the middle meningeal artery. The brief loss of consciousness and the physical findings, including mildly increased deep tendon reflexes on the right compared to the left, support this diagnosis.
Other Likely Diagnoses
- B) Cortical vein: Injury to a cortical vein could lead to a subdural hematoma, which might present with similar symptoms, including headache and altered mental status. However, the specific pattern of worsening with physical activity and lying down, along with the history of trauma, makes middle meningeal artery injury more likely.
- F) Transverse sinus: Thrombosis or injury to the transverse sinus could cause headache and might be considered in the differential, especially given the history of head trauma. However, the clinical presentation and the specific details provided do not as strongly support this diagnosis as they do the injury to the middle meningeal artery.
Do Not Miss Diagnoses
- C) Middle cerebral artery: Although less likely given the specific symptoms and history, an injury to the middle cerebral artery could result in an ischemic stroke or, if there's an associated aneurysm, a subarachnoid hemorrhage. These conditions are medical emergencies and must be considered, even if they are not the most likely diagnoses based on the information provided.
- A) Bridging veins: Injury to bridging veins could lead to a subdural hematoma, which is a serious condition requiring prompt diagnosis and treatment. The history of trauma and brief loss of consciousness necessitates considering this possibility, despite it being less likely than middle meningeal artery injury based on the clinical presentation.
Rare Diagnoses
- E) Superior sagittal sinus: Thrombosis of the superior sagittal sinus is a rare condition that could present with headache and might be considered in patients with a history of head trauma. However, it is less likely than other diagnoses listed here and would typically be associated with more specific findings, such as seizures or bilateral neurological deficits.
- Other vascular injuries: Other rare vascular injuries, including those to smaller cerebral arteries or veins, could potentially cause the patient's symptoms. However, these would be less common and might not as directly explain the patient's specific history and physical examination findings.