Trauma Nurse Core Course (TNCC) Practice Exam

For an elderly patient with a hematoma and symptoms after a fall, what is the most likely cause?

1. Epidural hematoma

2. Diffuse axonal injury

3. Post-concussive syndrome

4. Subdural hematoma

The correct answer is: Subdural hematoma

In the context of an elderly patient with a hematoma and symptoms following a fall, the most likely cause being a subdural hematoma is supported by several factors related to the physiological changes that occur with aging. The elderly often have an increased risk for subdural hematomas due to age-related atrophy of the brain, which can lead to a greater space between the brain and the dura mater. This increased space makes the bridging veins more susceptible to tearing during acceleration-deceleration injuries or falls, resulting in the accumulation of blood in the subdural space. Symptoms may include confusion, headache, or altered consciousness, which can emerge days to weeks after the injury, aligning with the often delayed presentation of subdural hematomas in older adults. This contrasts with other conditions that may present more acutely or with different mechanisms. For example, an epidural hematoma typically presents with a classic loss of consciousness followed by a brief period of lucidity, often following a more forceful impact, which is less common in the general circumstances of a fall among the elderly. While diffuse axonal injury and post-concussive syndrome are important considerations in traumatic brain injuries, they do not typically present with a localized hematoma as described in this case.