Differential Diagnosis for the Presented Case
The patient's history and symptoms suggest a traumatic brain injury, which has led to the development of brain lesions. The following differential diagnoses are considered:
- Single most likely diagnosis
- B. Chronic subdural hematoma: This is the most likely diagnosis given the patient's age, history of a fall, and the presence of hypodense brain lesions on the CT image. The fact that the patient did not experience immediate severe symptoms after the fall and only presented with general weakness and inability to stand or walk two weeks later suggests a chronic rather than acute process.
- Other Likely diagnoses
- D. Subacute subdural hematoma: Although less likely than a chronic subdural hematoma, a subacute subdural hematoma could also present with similar symptoms and imaging findings, especially if the patient's symptoms have been progressing over time.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A. Acute subdural hematoma: Although the patient's presentation is not typical for an acute subdural hematoma due to the delayed onset of severe symptoms, it is crucial not to miss this diagnosis as it requires immediate surgical intervention.
- C. Extradural hemorrhage: While extradural hemorrhages typically present with a loss of consciousness and more severe symptoms immediately after the trauma, a small or slowly expanding hemorrhage could potentially present with delayed symptoms.
- Rare diagnoses
- Other causes of hypodense brain lesions: Such as brain abscesses, cysts, or tumors, although these would be less likely given the patient's history of a recent fall and traumatic brain injury.
- Vascular causes: Like cerebral vasculitis or moyamoya disease, which could potentially cause similar symptoms and imaging findings but would be less likely in this context.
Each of these diagnoses should be considered in the context of the patient's overall clinical presentation, history, and imaging findings to determine the most appropriate course of action.