Head Injury Differential Diagnosis

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Concussion: This is the most common type of head injury, especially in the context of sports, falls, or minor accidents. A concussion is a mild traumatic brain injury that affects brain function, typically caused by a blow to the head.
• Other Likely Diagnoses
  • Subdural Hematoma: This condition involves bleeding into the space between the brain and the skull, often due to a severe head injury. It's a common concern in head trauma cases, especially in the elderly or those on anticoagulant therapy.
  • Epidural Hematoma: Similar to a subdural hematoma but involves bleeding between the skull and the dura mater, the outermost membrane covering the brain. It's often associated with a skull fracture and can be life-threatening if not promptly treated.
  • Skull Fracture: A break in one or more of the bones that form the skull, which can be caused by a severe blow to the head. The presence of a skull fracture increases the risk of other complications such as hematomas.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain (the subarachnoid space), which can be caused by a head injury or rupture of an aneurysm. It's critical to diagnose promptly as it can lead to severe complications or death.
  • Cerebral Edema: Swelling of the brain that can be caused by a head injury, leading to increased intracranial pressure. Early recognition and management are crucial to prevent brain herniation and death.
  • Meningitis: Infection of the protective membranes covering the brain and spinal cord, known as the meninges. While less common as a direct result of head injury, it's a critical diagnosis not to miss due to its high mortality rate if untreated.
• Rare Diagnoses
  • Arteriovenous Fistula: An abnormal connection between arteries and veins, which can occur in the brain following a penetrating head injury. It's rare but can lead to significant neurological deficits or hemorrhage if not treated.
  • CSF Leak: A leak of cerebrospinal fluid (CSF) from the brain or spinal cord, which can occur after a head injury, especially those involving fractures of the skull base. It's rare but can lead to meningitis or other serious complications.
  • Traumatic Aneurysm: A rare complication of head injury where an aneurysm (a bulge in a blood vessel) forms due to the trauma. It's critical to diagnose as it can rupture, leading to subarachnoid hemorrhage.