History of Present Illness (HPI)
The patient is a 38-year-old female who was involved in a high-speed motor vehicle accident 14 days ago. She lost consciousness at the scene and admits to alcohol consumption prior to the accident. Since the accident, she has experienced persistent nausea and severe band-like headaches rated 10/10 in intensity, occurring twice in the past two days. She has a laceration on the left shin area, which was sutured with 14 stitches and has become red, swollen, and infected, with a slight oozing of blood after two stitches were removed. She also reports left ankle swelling and slight swelling of the left leg without pain, redness, or warmth. Additionally, she complains of pain in the right shoulder area, which begins around the 90-degree angle when lifting her arm above her head.
Differential Diagnosis
- Single Most Likely Diagnosis
- Post-concussive syndrome: Given the patient's history of loss of consciousness and subsequent symptoms of persistent nausea and severe headaches, post-concussive syndrome is a likely diagnosis. The symptoms are consistent with the typical presentation of this condition.
- Other Likely Diagnoses
- Infected laceration: The patient's left shin laceration has become infected, as evidenced by redness, swelling, and oozing of blood, which is a common complication of traumatic injuries.
- Deep vein thrombosis (DVT): The patient's left ankle swelling and slight swelling of the left leg without pain, redness, or warmth could be indicative of a DVT, which is a common complication of traumatic injuries, especially in patients who have been immobile.
- Adhesive capsulitis (frozen shoulder): The patient's right shoulder pain, which begins around the 90-degree angle when lifting her arm above her head, could be indicative of adhesive capsulitis, which is a common condition that can occur after traumatic injuries.
- Do Not Miss Diagnoses
- Subdural hematoma or other intracranial hemorrhage: Although the patient's symptoms are consistent with post-concussive syndrome, it is essential to rule out more severe intracranial injuries, such as subdural hematoma or other intracranial hemorrhages, which can be life-threatening if missed.
- Osteomyelitis: The patient's infected laceration could potentially lead to osteomyelitis, a bone infection that can be severe and require prompt treatment.
- Pulmonary embolism: The patient's history of traumatic injury and potential DVT puts her at risk for pulmonary embolism, which is a life-threatening condition that requires immediate attention.
- Rare Diagnoses
- Chronic subdural hematoma: Although less common, chronic subdural hematoma can occur after traumatic injuries and may present with similar symptoms to post-concussive syndrome.
- Complex regional pain syndrome (CRPS): The patient's right shoulder pain and left ankle swelling could be indicative of CRPS, a rare condition that can occur after traumatic injuries.