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Differential Diagnosis for 77-year-old Female Patient

Single Most Likely Diagnosis

  • Subdural Hematoma: Given the patient's age, use of anticoagulants (Eliquis for A-fib), recent fall, and symptoms of weakness, this diagnosis is highly plausible. The fact that she hit her head and has been feeling weak since the fall increases the likelihood of a subdural hematoma.

Other Likely Diagnoses

  • Cervical Fracture or Strain: The patient's neck pain radiating to her left shoulder after a fall suggests a possible cervical spine injury, which is common in elderly patients after falls.
  • Musculoskeletal Injury (e.g., hip fracture): Although the patient landed on her left side and has a hematoma on her left leg, a musculoskeletal injury such as a hip fracture should be considered, especially given her age and the mechanism of injury.
  • Intracranial Hemorrhage (other than subdural hematoma): Given the patient's anticoagulation therapy and the fall, other types of intracranial hemorrhages (e.g., intraparenchymal, epidural, or subarachnoid hemorrhage) are possible.

Do Not Miss Diagnoses

  • Spinal Cord Injury: Although less likely, a spinal cord injury could present with neck pain and weakness, especially if the patient has a cervical spine fracture or dislocation. This diagnosis is critical to identify promptly to prevent further injury.
  • Epidural Hematoma: This is a medical emergency that can present with neck pain and neurological deficits. Given the patient's use of anticoagulants and recent trauma, it's crucial not to miss this diagnosis.
  • Cervical Vertebral Artery Dissection: This condition can occur after a fall and presents with neck pain and neurological symptoms. It's a critical diagnosis to consider due to the risk of stroke.

Rare Diagnoses

  • Hemophilia or Other Bleeding Disorder Complications: Although the patient mentions a bleeding disorder, the specifics are unclear. Complications from hemophilia or other bleeding disorders could be considered, especially given her anticoagulation therapy and recent trauma.
  • Osteoporotic Compression Fracture: While not directly related to the fall, the patient's age and possible osteoporosis could predispose her to compression fractures, which might present with back or neck pain.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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