Differential Diagnosis for Head Injury
The patient presents with a history of assault, loss of consciousness, and a moderate headache, along with physical findings of abrasions, lacerations, and ecchymoses. The CT scan of the head shows a skull fracture and a lens-shaped, high-density collection in the left occipital lobe. Based on these findings, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- D) Ruptured middle meningeal artery: This is the most likely cause of the lens-shaped, high-density collection seen on the CT scan, which is characteristic of an epidural hematoma. The middle meningeal artery is commonly injured in association with a temporal bone fracture, leading to epidural bleeding.
Other Likely Diagnoses
- C) Ruptured bridging veins between the surface of the brain and the dural sinuses: This would result in a subdural hematoma, which can also present with a high-density collection on CT scan but is typically more crescent-shaped rather than lens-shaped.
- A) Diffuse intraparenchymal hemorrhage: Although less likely given the description of the hematoma as lens-shaped, intraparenchymal hemorrhage could be considered, especially if there were other signs of brain injury.
Do Not Miss Diagnoses
- E) Ruptured scalp blood vessels: While less likely to cause the intracranial findings described, significant scalp injuries can lead to substantial blood loss and should not be overlooked.
- B) Diffuse periosteal bleeding: This could contribute to the patient's overall condition, particularly if there are significant soft tissue injuries, but is less directly related to the CT findings.
Rare Diagnoses
- Other rare causes of intracranial hemorrhage, such as vascular malformations or tumors, are less likely given the acute presentation following trauma but should be considered if the patient's condition does not improve as expected with treatment of the identified injuries.