Differential Diagnosis for Patient on Plavix and Aspirin with Headache and Stiff Neck after a Fall

• Single most likely diagnosis:
  • Subdural hematoma: The patient is on anticoagulants (Plavix and aspirin), which increases the risk of bleeding, especially after a traumatic event like a fall. A subdural hematoma is a common and serious consequence of head trauma in anticoagulated patients, presenting with headache and stiff neck.
• Other Likely diagnoses:
  • Cervical strain or sprain: The mechanism of injury (fall) could result in muscle strain or ligament sprain in the neck, leading to stiffness and pain.
  • Concussion: Given the history of a fall and hitting the head, a concussion is a possible diagnosis, which could also explain the headache.
  • Epidural hematoma: Although less likely than subdural hematoma in the context of anticoagulation, an epidural hematoma is still a possibility, especially with significant head trauma.
• Do Not Miss diagnoses:
  • Subarachnoid hemorrhage: Although less common, a subarachnoid hemorrhage could occur due to trauma and would be catastrophic if missed. The presence of anticoagulants increases the risk of worsening hemorrhage.
  • Cervical spine fracture: A fracture in the cervical spine could lead to neck stiffness and is critical to identify to prevent further injury, especially spinal cord damage.
  • Meningitis: While less directly related to the trauma, in an anticoagulated patient with a potential breach in the skin or mucous membranes, meningitis could be a life-threatening condition presenting with headache and stiff neck.
• Rare diagnoses:
  • Arteriovenous fistula or malformation: Trauma could potentially cause or exacerbate an arteriovenous fistula or malformation, leading to headache and other neurological symptoms.
  • Spinal epidural hematoma: Although rare, this condition could occur, especially in the context of anticoagulation and trauma, and would require urgent intervention to prevent neurological deterioration.