Differentials
Epidural hematoma
SIGNS / SYMPTOMS
"Lucid interval," younger patients, usually an associated skull fracture.
INVESTIGATIONS
CT of the brain shows lenticular shape that does not cross suture lines.
Intracerebral hematoma
SIGNS / SYMPTOMS
There may be no differences in symptoms and signs.
INVESTIGATIONS
CT of the brain.
Diffuse axonal injury
SIGNS / SYMPTOMS
History of trauma involving shear or acceleration/deceleration force; high-grade diffuse axonal injury typically results in coma.
INVESTIGATIONS
CT of the brain, MRI of the brain with gradient-recalled echo or susceptibility-weighted imaging.
Stroke
SIGNS / SYMPTOMS
Fall may be involved, sudden onset of deficit before the fall, may have history of atrial fibrillation or cardiac arrhythmia, or history of prothrombotic disorder.
INVESTIGATIONS
CT of the brain, MRI of the brain with diffusion and perfusion-weighted imaging, magnetic resonance angiography.
Seizure
SIGNS / SYMPTOMS
After postictal state, patient typically returns to baseline. There may be a lingering Todd's paralysis for up to 48 hours after the seizure.
INVESTIGATIONS
Electroencephalogram.
Substance abuse
SIGNS / SYMPTOMS
There may be no differences in symptoms and signs, although there is often no history of trauma.
INVESTIGATIONS
Toxicology screen may be useful in differentiating causes of altered mental status.
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