Differential Diagnosis for a 28yo Male with Suspected Concussion after Muay Thai Sparring

When assessing a 28-year-old male for concussion after participating in Muay Thai sparring, and he denies vomiting or loss of consciousness, several differential diagnoses should be considered. These can be categorized into the single most likely diagnosis, other likely diagnoses, do not miss diagnoses, and rare diagnoses.

• Single Most Likely Diagnosis

  • Concussion: This is the most likely diagnosis given the context of the injury (trauma to the head during sparring) and the symptoms that typically follow such an event, including confusion, disorientation, and possibly memory problems, even without loss of consciousness.

• Other Likely Diagnoses

  • Subconcussive Injury: Repeated blows to the head can cause subconcussive injuries, which may not present with overt symptoms of concussion but can still affect cognitive function and increase the risk of further injury.
  • Cervical Strain or Whiplash: The force of being hit or falling could also result in strain to the neck muscles or a whiplash injury, leading to neck pain and stiffness.
  • Facial or Dental Injuries: Given the nature of Muay Thai, injuries to the face, including lacerations, fractures, or dental injuries, are possible and should be assessed.

• Do Not Miss Diagnoses

  • Epidural or Subdural Hematoma: Although less likely without loss of consciousness, these conditions can present with delayed symptoms and are medical emergencies requiring immediate intervention.
  • Skull Fracture: A fracture could occur from a significant impact and might not always present with immediate severe symptoms, making it crucial to assess for signs such as CSF leak, severe headache, or neurological deficits.
  • Cervical Spine Injury: Any injury that involves a blow to the head or a fall also risks injury to the cervical spine, which could lead to serious neurological consequences if not promptly identified and managed.

• Rare Diagnoses

  • Post-Traumatic Seizure: While rare, seizures can occur after head trauma, even in the absence of other significant symptoms.
  • Arteriovenous Fistula or Carotid/Vertebral Artery Dissection: These vascular injuries are rare but can have severe consequences, including stroke, and should be considered in the differential diagnosis, especially if there are symptoms suggestive of vascular compromise.