Elderly patients with conservatively managed subdural haemorrhage should have a follow-up plan

A 94-year-old retired accountant presented to A&E in November 2010 following a fall at home. He was unsure of the events but thinks that his legs gave way and he fell hitting his head on the kitchen worktop on the way down. Of note, he had fallen four times during the year preceding this fall. A computerized tomography (CT) of the head was performed and reported as showing a subdural collection in the right frontal temporo-parietal region causing a 3-mm midline shift to the left which could represent an old subdural haematoma with some hyperacute changes (Figure 1, A and C). Fresh blood was not noted. The case was discussed with the local neurosurgical hospital who advised that the patient was for conservative management in view of a normal neurological examination and a glasgow coma scale (GCS) of 15/15. After a short hospital stay, the patient was discharged to intermediate care for rehabilitation before returning home and his aspirin was stopped. No follow-up was put in place for this patient. Figure 1. ( A and C ) Unenhanced CT head performed on November 23, 2010 at initial presentation showing right frontotemporal parietal subdural collection with left-sided midline shift of 3 mm. ( B and D ) Repeat unenhanced CT head performed on February 3, 2011 demonstrating a significant increase in the right frontotemporal parietal lobe subdural collection with left-sided midline shift of 8.1 mm and mass effect. There is also partial effacement and left-sided deviation of the …