Differential Diagnosis for Head Injury

The patient presents with a history of head trauma, intermittent headache, vertigo, nausea, and fatigue. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Post-Concussive Syndrome: This is the most likely diagnosis given the patient's history of head trauma, symptoms of headache, vertigo, nausea, and fatigue. These symptoms are consistent with the typical presentation of post-concussive syndrome, which often occurs after a mild traumatic brain injury.

• Other Likely Diagnoses

  • Tension Headache: The patient's complaint of intermittent headache could also be attributed to a tension headache, which is a common type of headache that can be exacerbated by stress, fatigue, or minor injuries.
  • Benign Paroxysmal Positional Vertigo (BPPV): The patient's report of vertigo with movement that subsides within one minute is consistent with BPPV, a condition related to the inner ear that can be triggered by head trauma.
  • Cervicogenic Headache: The mechanism of injury and the presence of headache could also suggest a cervicogenic headache, which originates from the cervical spine and can be caused by trauma or strain.

• Do Not Miss Diagnoses

  • Subdural Hematoma or Epidural Hematoma: Although the patient denies loss of consciousness, these conditions can present with delayed symptoms and are potentially life-threatening if not promptly diagnosed and treated.
  • Subarachnoid Hemorrhage: This is another serious condition that can occur after head trauma and requires immediate medical attention.
  • Skull Fracture: The patient's concern about the scratch on her head getting infected highlights the importance of evaluating for a potential skull fracture, which could lead to complications such as meningitis.

• Rare Diagnoses

  • Arteriovenous Fistula or Malformation: These vascular abnormalities can be caused by trauma and might present with headache, vertigo, or other neurological symptoms, although they are less common.
  • Chiari Malformation: This condition involves a structural defect in the cerebellum that can be symptomatic after a head injury, presenting with headache, vertigo, and other neurological symptoms. However, it is relatively rare and usually diagnosed incidentally or in the context of other symptoms.