Differential Diagnosis for 50 yo Male with Traumatic Brain Injury

Single Most Likely Diagnosis

• Post-Concussion Syndrome: The patient's history of traumatic brain injury, post-concussion headaches, and current symptoms of headaches and not feeling well after another head injury are consistent with post-concussion syndrome. The absence of acute intracranial findings on the plain head CT also supports this diagnosis.

Other Likely Diagnoses

• Chronic Subdural Hematoma: Although the plain head CT showed no acute intracranial findings, the patient's history of traumatic brain injury and subarachnoid hemorrhage increases the risk of chronic subdural hematoma. The patient's symptoms of headaches and not feeling well could be indicative of a chronic subdural hematoma.
• Cervicogenic Headache: The patient's neck CT was unremarkable, but the mechanism of injury (a 50 lbs package falling on his head) could have caused cervical spine injury or strain, leading to cervicogenic headache.
• Mild Traumatic Brain Injury (mTBI): The patient's loss of consciousness, nausea, and disorientation after the recent head injury are consistent with mTBI. The patient's ongoing symptoms of headaches and not feeling well could be related to mTBI.

Do Not Miss Diagnoses

• Epidural Hematoma: Although the plain head CT showed no acute intracranial findings, an epidural hematoma can be a life-threatening condition that requires prompt diagnosis and treatment. The patient's mechanism of injury and symptoms of headaches and not feeling well warrant consideration of this diagnosis.
• Cervical Spine Fracture: The patient's neck CT was unremarkable, but a cervical spine fracture can be a life-threatening condition that requires prompt diagnosis and treatment. The patient's mechanism of injury and symptoms of headaches and not feeling well warrant consideration of this diagnosis.
• Intracranial Aneurysm: The patient's history of subarachnoid hemorrhage increases the risk of intracranial aneurysm. The patient's symptoms of headaches and not feeling well could be indicative of an intracranial aneurysm.

Rare Diagnoses

• Second Impact Syndrome: This is a rare condition that occurs when an individual suffers a second concussion before the symptoms of the first concussion have resolved. The patient's history of traumatic brain injury and post-concussion headaches, followed by another head injury, makes this diagnosis a possibility.
• Dural Venous Sinus Thrombosis: This is a rare condition that can occur after a head injury. The patient's symptoms of headaches and not feeling well could be indicative of dural venous sinus thrombosis.