Differential Diagnosis
- Single most likely diagnosis
- Traumatic Brain Injury (TBI) with acute subdural hematoma: The presence of a large right hemispheric mixed acute subdural hematoma, midline shift, uncal herniation, and descending transtentorial herniation suggests a severe head injury, which is the most likely cause of the patient's condition.
- Other Likely diagnoses
- Spontaneous intracranial hemorrhage: Although less likely than TBI, spontaneous intracranial hemorrhage could be a possible cause of the subdural hematoma, especially in the context of underlying vascular malformations or tumors.
- Metastatic disease with hemorrhage: The patient's known history of colon cancer and presence of bilateral metastatic pulmonary nodules raise the possibility of metastatic disease with hemorrhage, although this is less likely given the acute presentation and lack of other suggestive findings.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aneurysmal rupture: Although the CT angiogram did not show any significant stenosis or occlusion, aneurysmal rupture could be a life-threatening condition that requires prompt diagnosis and treatment.
- Arteriovenous malformation (AVM) with hemorrhage: AVMs can cause intracranial hemorrhage, and although less likely, this diagnosis should be considered to avoid missing a potentially treatable condition.
- Venous sinus thrombosis: The presence of subdural hematoma and hydrocephalus could be related to venous sinus thrombosis, which requires prompt anticoagulation to prevent further complications.
- Rare diagnoses
- Hemorrhagic transformation of an ischemic stroke: Although the CT angiogram did not show any significant stenosis or occlusion, hemorrhagic transformation of an ischemic stroke could be a rare cause of the subdural hematoma.
- Coagulopathy-related hemorrhage: The patient's underlying cancer and potential coagulopathy could increase the risk of hemorrhage, although this is a rare cause of subdural hematoma.