Differential Diagnosis for Head Injury

The patient's presentation suggests a severe head injury with signs of increased intracranial pressure and potential brain herniation. The key findings include a decreased level of consciousness (GCS of 6), a dilated pupil, bradycardia, and hypertension, which are indicative of the Cushing's reflex. The CT scan reveals a lenticular shaped collection, which is characteristic of an epidural hematoma.

• Single most likely diagnosis

  • Epidural Hematoma: The patient's symptoms, including the loss of consciousness, dilated pupil, and the lenticular shaped collection on CT scan, are classic for an epidural hematoma. This condition is often caused by a temporal bone fracture that damages the middle meningeal artery, leading to rapid accumulation of blood between the dura and the skull.

• Other Likely diagnoses

  • Subdural Hematoma: Although less likely given the lenticular shape on CT, a subdural hematoma could still be considered, especially if there's a possibility of venous bleeding or if the patient has a different type of injury.
  • Intracerebral Hemorrhage: This could be a consideration if the CT scan showed a more irregularly shaped hemorrhage within the brain parenchyma, but the lenticular shape points more towards an epidural location.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Subarachnoid Hemorrhage: Although the CT findings do not directly suggest this, any head injury could potentially cause a subarachnoid hemorrhage, which would require immediate attention.
  • Brain Herniation: The patient's symptoms, such as the dilated pupil and decreased level of consciousness, suggest impending or actual brain herniation, which is a medical emergency.
  • Cervical Spine Injury: Given the mechanism of injury, it's crucial to rule out a cervical spine injury, as these can be devastating if missed.

• Rare diagnoses

  • Arteriovenous Malformation (AVM) or Aneurysm Rupture: These vascular anomalies could potentially cause hemorrhage after a head injury, although they would be less common and might not present with the characteristic lenticular shape on CT.
  • Traumatic Pseudocyst: A rare condition that could mimic some of the symptoms but would be less likely given the acute presentation and specific CT findings.