Question

A 76-year-old elderly patient presents in a confused state. He is on antihypertensive medication and on aspirin due to a previous heart attack. There is a minor trauma due to fall from a chair 3 weeks back. NCCT is done and shows the following. Diagnosis?

• A. SAH (Subarachnoid Hemorrhage)
• B. EDH (Epidural Hematoma)
• C. Normal Study
• D. Chronic SDH (Subdural Hematoma)

Hint:

Chronic SDH often presents with subtle symptoms such as confusion and is typically seen in elderly patients after minor head trauma.

Answer 1

The Correct Option is D

The scenario describes an elderly patient with confusion, a recent minor trauma, and a history of medication use that could affect bleeding, such as antihypertensive medication and aspirin. These factors are crucial in forming a diagnosis based on the patient's presentation and NCCT findings.

The key points to consider are:

1. Age and Symptoms: The patient is 76 years old, and confusion is a common symptom in elderly patients with brain injuries or bleeding.
2. Medication History: Use of aspirin and antihypertensives may increase the risk of bleeding.
3. Trauma History: A fall from a chair 3 weeks ago could lead to a delayed bleed, considering the mechanism of injury.
4. NCCT Findings: In chronic cases, an NCCT can reveal a subdural hematoma as a crescent-shaped collection on the brain's surface.

Given these factors, we assess the options provided:

Option	Explanation
SAH (Subarachnoid Hemorrhage)	Typically presents with sudden headache, not consistent with the given history of trauma and confusion in an older patient with a medicated bleeding risk.
EDH (Epidural Hematoma)	Commonly associated with temporal bone fractures and present acutely, not likely 3 weeks post-injury in an older patient without a direct head strike.
Normal Study	Unlikely given the confusion and history of recent trauma indicating possible bleeding complications.
Chronic SDH (Subdural Hematoma)	Consistent with the delayed presentation after minor trauma in an elderly patient on aspirin.

Based on the context and presented options, Chronic SDH (Subdural Hematoma) best fits the patient's condition and CT findings.