Question

An elderly man falls, his head hits the sidewalk. He does not lose consciousness but 4 hours later begins to feel dizzy with right-sided weakness. He is taken to the ER for examination, no skull fracture is found. Which of the following conditions does he most likely have?

1) Subdural hematoma
2) Concussion
3) Epidural hematoma
4) Contusion

Answer 1

The most likely diagnosis for the elderly man who fell, hit his head, and experienced delayed neurological symptoms is a subdural hematoma due to its alignment with the gradual development of symptoms and absence of a skull fracture.

Step-by-step explanation:

Given the symptoms of dizziness and right-sided weakness that appeared several hours after the fall, along with the absence of a skull fracture, the elderly man in the emergency room (ER) most likely has a subdural hematoma. Subdural hematomas are a type of brain injury that occur when blood collects between the dura mater, the tough outer layer of the meninges, and the brain surface. This can slowly increase pressure on the brain, causing neurological symptoms to develop over a period of hours to days, which aligns with the progression of symptoms described. Given that there is no skull fracture, an epidural hematoma is less likely, as it commonly occurs from arterial bleeding due to a fracture that impacts a blood vessel, leading to more rapid symptom onset. A concussion, while common and the mildest type of brain injury, generally causes immediate and more transient symptoms. A contusion, or bruise of the brain, might be considered but the delayed onset of symptoms and absence of immediate loss of consciousness make a subdural hematoma more plausible.