Differential Diagnosis for the Boyfriend's Symptoms

The symptoms described, including dizziness, sharp pains in the head, soreness to touch on the outside of the head, and worsening eyesight with blurry vision, following a head injury with a hammer, suggest a range of possible diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Chronic Subdural Hematoma: This condition is a strong possibility given the history of head trauma and the delayed onset of symptoms such as dizziness, sharp pains, and worsening eyesight. A chronic subdural hematoma can develop slowly over weeks after a head injury, especially in the elderly or in individuals with significant brain atrophy, but it can also occur in younger individuals after significant trauma.

• Other Likely Diagnoses

  • Post-Concussion Syndrome: This condition can occur after a head injury and is characterized by symptoms such as headache, dizziness, and difficulty concentrating. The blurry vision could be part of the syndrome, although it's less common.
  • Traumatic Brain Injury (TBI) Complications: Depending on the severity of the initial injury, there could be various complications arising from the TBI, including but not limited to, intracranial hemorrhages, cerebral edema, or even post-traumatic seizures, which could explain the sharp pains and worsening vision.
  • Post-Traumatic Migraines: These can develop after a head injury and may include symptoms of headache, sensitivity to light, and in some cases, visual disturbances.

• Do Not Miss Diagnoses

  • Epidural Hematoma: Although less likely given the delayed onset of severe symptoms, an epidural hematoma is a medical emergency that requires immediate attention. It can present with a loss of consciousness, severe headache, and other neurological deficits.
  • Subarachnoid Hemorrhage: This is another critical condition that could present with sudden severe headache and could be a result of the trauma. It's less likely given the gradual onset of symptoms but should not be missed.
  • Infection (Meningitis or Abscess): If the scalp wound became infected, it could lead to more serious conditions like meningitis or a brain abscess, especially if there were open wounds or if the hammer was contaminated.

• Rare Diagnoses

  • Arteriovenous Fistula or Malformation: Trauma can rarely cause the formation of abnormal connections between arteries and veins in the brain, leading to various symptoms including headache and visual disturbances.
  • Traumatic Pseudomeningocele: This is a rare condition where there is a collection of cerebrospinal fluid (CSF) outside the dura mater, which can occur after trauma and might cause headache and other neurological symptoms.

It's crucial for the boyfriend to seek immediate medical attention, given the severity and progression of his symptoms. A thorough evaluation, including imaging studies like a CT or MRI of the head, is necessary to determine the exact cause of his symptoms.