Differential Diagnosis for 81 year old female with unwitnessed fall 4.5 days ago, LOC, amnesia, on apixaban

• Single most likely diagnosis:
  • Intracranial hemorrhage (ICH): Given the patient's age, unwitnessed fall, loss of consciousness (LOC), amnesia, and anticoagulation with apixaban, ICH is a highly probable diagnosis. The fall could have caused a traumatic brain injury, and the anticoagulant increases the risk of bleeding.
• Other Likely diagnoses:
  • Subdural hematoma: A common consequence of falls in the elderly, especially with a history of trauma and anticoagulation.
  • Concussion or mild traumatic brain injury: Possible given the mechanism of injury and symptoms of LOC and amnesia.
  • Orthopedic injuries (e.g., hip fracture): Elderly individuals are prone to fractures after falls, which could be the primary issue or complicate other diagnoses.
• Do Not Miss diagnoses:
  • Spinal cord injury or cervical spine fracture: Given the mechanism of injury, it's crucial to consider spinal injuries, especially in the elderly, as they can have severe consequences if missed.
  • Epidural hematoma: Although less common than subdural hematoma, it's a critical diagnosis to consider due to its potential for rapid deterioration and need for urgent intervention.
  • Medication-related complications (e.g., apixaban overdose or interaction): While apixaban is mentioned, ensuring it's not contributing to an increased risk of bleeding or interacting with other medications is vital.
• Rare diagnoses:
  • Arteriovenous malformation (AVM) or aneurysm rupture: Although less likely, these vascular abnormalities could cause ICH and should be considered, especially if there's no clear traumatic cause.
  • Infection (e.g., meningitis, encephalitis): Infections can cause altered mental status and should be considered, especially if there are other systemic signs of infection.
  • Metabolic or electrolyte disturbances: Conditions like hypoglycemia, hyponatremia, or hypercalcemia can cause altered mental status and should be ruled out, particularly in the elderly.