Differential Diagnosis for a 73-year-old Female with Immediate Loss of Consciousness and Subsequent Headache

• Single most likely diagnosis:
  • Epidural hematoma: This condition is characterized by a brain hematoma not limited by suture lines, which can occur after a head injury, such as a fall. The initial loss of consciousness followed by a lucid interval (a period of time during which the person is conscious and able to interact normally) and then subsequent deterioration with symptoms like headache is classic for an epidural hematoma. The fact that it's not limited by suture lines is key, as epidural hematomas can cross suture lines due to their location between the dura and the skull.
• Other Likely diagnoses:
  • Subdural hematoma: This is another type of brain hematoma that could occur after a fall. It is typically concave in shape and is limited by suture lines because it occurs between the dura and the arachnoid membranes. While the presentation can be similar to an epidural hematoma, the mechanism and the fact that it usually doesn't cross suture lines differentiate it.
  • Subarachnoid hemorrhage: Although less directly related to the mechanism of a fall, a subarachnoid hemorrhage could present with sudden headache and loss of consciousness. It's a consideration, especially if there's suspicion of an aneurysm or other vascular anomaly.
• Do Not Miss diagnoses:
  • Intracerebral hemorrhage: This is a serious condition that could present with sudden loss of consciousness and headache. It's crucial not to miss because timely intervention can significantly impact outcomes.
  • Cervical spine injury: Given the mechanism of injury (a fall), it's critical to consider and rule out cervical spine injuries, which could have devastating consequences if missed.
• Rare diagnoses:
  • Arteriovenous malformation (AVM) rupture: While rare, an AVM rupture could present with sudden neurological symptoms, including loss of consciousness and headache, after a minor trauma.
  • Traumatic aneurysm: This is a rare complication of head trauma and could present with delayed symptoms, including headache and loss of consciousness, due to rupture of the aneurysm.

Each of these diagnoses has a different set of implications for treatment and prognosis, making a thorough differential diagnosis crucial in the management of this patient.