An 81-year-old patient with heart failure comes into the emergency room accompanied by his daughter. The daughter reports that her father banged his head as he was getting out of the car 4 days ago. He did not complain of headache pain, so she did not obtain medical advice. She reports that she noticed a mild facial droop, slurring of speech, and gait disturbance in her father today. She reports that her father takes Coumadin, digoxin, and an ACE inhibitor. On physical examination, there is decreased right hand grip 2/5 strength and decreased right quadriceps strength 2/5 compared to the left side 5/5. Computed tomography scan shows an intracranial bleed. Which of the following is the most probable diagnosis?

Question

Quizplus · Accepted Answer

The most probable diagnosis is a subdural hematoma, which is common in elderly patients, especially those on anticoagulation therapy like Coumadin. The symptoms developed gradually over days, which is typical for subdural hematomas, as they can slowly accumulate blood between the dura mater and the brain.

An 81-Year-Old Patient with Heart Failure Comes into the Emergency