Differential Diagnosis

• Single most likely diagnosis
  • C. Subacute subdural haematoma: This is the most likely diagnosis given the patient's history of a fall 2 weeks ago, presenting with a disturbed level of consciousness, and a CT scan showing a concave frontal lesion. Subacute subdural hematomas can present with delayed onset of symptoms and can cause increased intracranial pressure, leading to a decrease in the level of consciousness.
• Other Likely diagnoses
  • A. Axonal brain injury: This could be a consideration given the mechanism of injury (fall on the head) and the presentation with a disturbed level of consciousness. However, axonal brain injury typically presents with more diffuse damage on imaging and may not always correlate with a focal lesion like a concave frontal lesion.
  • B. Coup & Countercoup injury: While this is a possible diagnosis given the mechanism of injury, it is less likely than subacute subdural hematoma given the specific imaging findings and the delayed presentation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Epidural hematoma: Although less likely given the subacute presentation, an epidural hematoma can present with a similar history and imaging findings. It is crucial to consider this diagnosis due to its potential for rapid deterioration and high mortality if not promptly treated.
  • Subarachnoid hemorrhage: This could be a consideration, especially if there are other symptoms or signs suggestive of bleeding into the subarachnoid space. Prompt diagnosis is critical due to the potential for severe complications.
• Rare diagnoses
  • Chronic subdural hematoma: While possible, this is less likely given the relatively short timeframe since the injury. Chronic subdural hematomas typically present weeks to months after the initial injury.
  • Arteriovenous malformation (AVM) or other vascular anomalies: These are rare but could potentially present with hemorrhage after a minor trauma. They are less likely given the context but should be considered if other diagnoses are ruled out.