Differential Diagnosis for Patient with Increased Confusion and Unsteady Gait after Head Injury

Single Most Likely Diagnosis

• Post-Concussive Syndrome: This condition is a common sequela of head injury, characterized by symptoms such as confusion, difficulty with balance and coordination (unsteady gait), and other cognitive and emotional disturbances. The initial CT scan may not show any abnormalities, as post-concussive syndrome is a clinical diagnosis based on symptoms rather than imaging findings.

Other Likely Diagnoses

• Subdural Hematoma: Although the initial CT scan was normal, small subdural hematomas might not be visible on the first scan, especially if they are small or isodense to the brain. Symptoms can develop over time as the hematoma expands.
• Traumatic Subarachnoid Hemorrhage: This condition can also present with delayed symptoms, including confusion and gait disturbances, even if the initial CT scan did not show significant findings.
• Diffuse Axonal Injury (DAI): DAI can result from shearing forces during the head injury, leading to damage of the brain's white matter. It might not be immediately apparent on a CT scan but can cause significant cognitive and motor symptoms.

Do Not Miss Diagnoses

• Epidural Hematoma: Although less common than subdural hematomas, epidural hematomas can be life-threatening and require immediate surgical intervention. They might not be visible on an initial CT scan if they are small or if the scan was done too early.
• Cerebral Vasospasm: This condition can occur after subarachnoid hemorrhage and lead to decreased blood flow to parts of the brain, causing confusion, gait disturbances, and other neurological deficits.
• Infection (Meningitis or Abscess): Infections can complicate head injuries, especially if there was an open wound or CSF leak. They can present with non-specific symptoms such as confusion and gait disturbances.

Rare Diagnoses

• Fat Embolism Syndrome: This is a rare condition that can occur after long bone fractures but can also be associated with head injuries. It presents with a petechial rash, respiratory distress, and neurological symptoms.
• Cerebral Venous Thrombosis: This condition involves a clot in the veins that drain blood from the brain. It can present with a variety of symptoms, including confusion and gait disturbances, and is more common in patients with certain risk factors such as coagulopathy or dehydration.