Differential Diagnosis for Old Age Male Patient with Neurological Manifestation after Head Injury
- Single most likely diagnosis
- B. Subacute subdural haematoma: This is the most likely diagnosis given the patient's age, the mechanism of injury (fall on the head), and the timing of presentation (1 week after the injury). Subacute subdural hematomas often present with delayed neurological deterioration, which fits the patient's scenario. The concave lesion seen on the brain CT is also consistent with a subdural hematoma.
- Other Likely diagnoses
- A. Concussion: Although less likely given the presence of a concave lesion on CT, a concussion could still be considered, especially if the patient had initial symptoms that resolved but then worsened. However, the CT findings would not typically show a concave lesion in the case of a simple concussion.
- D. Traumatic subarachnoid hemorrhage: This could be a consideration, especially if the CT showed blood in the subarachnoid space. However, the description of a "concave lesion" is less typical for subarachnoid hemorrhage.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C. Extradural haematoma: Although extradural (epidural) hematomas are more commonly associated with a lucent interval followed by rapid deterioration and are typically seen with a biconvex or lens-shaped appearance on CT, they can occasionally present in a subacute manner, especially in older patients or those on anticoagulation. Missing this diagnosis could be catastrophic due to the potential for rapid deterioration and the need for urgent surgical intervention.
- Rare diagnoses
- Other rare possibilities could include chronic subdural hematoma if the patient had a history of repeated falls or intracerebral hemorrhage not directly related to the trauma, but these would be less likely given the acute presentation after a fall. Arteriovenous malformation (AVM) or aneurysm rupture could also be considered in the differential for subarachnoid hemorrhage but would be rare and not directly related to the trauma unless the trauma precipitated the rupture.