Differential Diagnosis for a 2-Month-Old Who Fell on Her Head
Single Most Likely Diagnosis
- Benign Scalp Hematoma or Soft Tissue Injury: This is the most likely diagnosis given the age of the child and the mechanism of injury. A fall onto the head can cause bruising or swelling of the scalp, which is usually self-limiting and resolves without significant sequelae.
Other Likely Diagnoses
- Linear Skull Fracture: A fall from a height or onto a hard surface can result in a linear skull fracture, especially in infants whose skulls are softer and more pliable.
- Subgaleal Hematoma: This condition involves bleeding into the space between the skull and the scalp, which can occur after a head injury. It's more common in infants due to their loose scalp tissue.
- Concussion or Mild Traumatic Brain Injury (mTBI): Although less common in infants due to the protective nature of their developing brains and open fontanelles, a concussion is possible, especially if the fall was from a significant height or onto a hard surface.
Do Not Miss Diagnoses
- Abusive Head Trauma (Shaken Baby Syndrome): It's crucial to consider non-accidental trauma, especially in infants who are unable to communicate the circumstances of their injury. Signs such as retinal hemorrhages, multiple fractures at different healing stages, or a inconsistent history may suggest abuse.
- Epidural or Subdural Hematoma: These are serious conditions that can result from a head injury, where blood accumulates between the skull and the brain or between the brain's surface and its outer covering, respectively. Prompt recognition and treatment are critical to prevent severe brain damage or death.
- Intracranial Hemorrhage: Bleeding within the brain itself can occur after a head injury and is a medical emergency requiring immediate attention.
Rare Diagnoses
- Depressed Skull Fracture: While possible, depressed skull fractures are less common in infants due to the pliability of their skulls. However, they can occur, especially with significant force or penetration.
- Growing Skull Fracture (Leptomeningeal Cyst): This rare complication of a skull fracture can occur weeks to months after the initial injury, where the fracture gradually enlarges due to the erosion of the bone edges by the underlying leptomeninges.
- Arteriovenous Fistula or Malformation: Trauma can, in rare instances, lead to the formation of abnormal connections between arteries and veins in the brain, which can cause a variety of symptoms depending on their location and size.