A nurse is assigned to a 75-year-old patient with head trauma secondary to falling down the stairs at home. The patient is stable initially, complaining of headache and some dizziness, but no focal neurologic signs. That evening, the patient acutely becomes altered and rapidly loses consciousness. Which of the following most likely explains this patient’s condition?

Question

A nurse is assigned to a 75-year-old patient with head trauma secondary to falling down the stairs at home.  The patient is stable initially, complaining of headache and some dizziness, but no focal neurologic signs.  That evening, the patient acutely becomes altered and rapidly loses consciousness.  Which of the following most likely explains this patient&rsquo;s condition?

Accepted Answer

Head trauma resulted in a tearing of the bridging veins with subsequent slow bleed into the subdural space. A subdural hematoma is caused by tearing of the bridging veins that traverse the subdural space with subsequent bleeding into the subdural space.  Elderly patients are at increased risk to develop this type of bleed since age-related loss of cortical volume results in stress on these vessels, making them prone to rupture.  This elderly patient with a history of recent head trauma likely tore one or more of these bridging veins when he sustained the head trauma and the slow venous bleeding resulted in altered mental status and loss of consciousness many hours later.  Arterial bleeding from a laceration of the middle meningeal artery, an epidural hematoma, would present much more acutely this patient.  Rupture of an artery on the base of the brain would likewise present much more acutely.  Vascular malformations (either arteriovenous malformation (AVMs) or berry aneurysms, can bleed slowly when they rupture depending on the hemodynamics however bleeding into the brain parenchyma would present with more focal neurologic signs than this patient.

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