Intracranial Hemorrhage After a Fall in Elderly Patients

Grandma fell and has intracranial hemorrhage?

My grandmother, 81 years old, fell at home on May 28 and bled a lot without realizing it, then went to sleep.
About four hours later, she was discovered and taken to the emergency room, where she received seven stitches on her head.
A 5 cm hematoma was found in her skull.
Since she also needed dialysis, the doctor issued a critical condition notice and she was immediately admitted to the intensive care unit.
Initially, she was doing well and could converse normally, but today when we visited, she appeared disoriented and noticeably emaciated.
However, she was still able to talk to us, although she was experiencing some hallucinations.
She expressed that she was in a lot of pain and wanted to go home, and her hands and feet were restrained.
When we asked the nurse about the bruising, she mentioned that it would need to be absorbed by the body naturally.
The doctor did not provide any specific updates, and my mother was advised to be mentally prepared.
Our family is unsure of what to do and can only continue to observe and wait for her condition to improve.

Jia Wen, 20~29 year old female. Ask Date: 2016/06/01

Dr. Zhang Junwei reply Neurosurgery

It seems that the current treatment plan is to control the bleeding with medication; otherwise, if the blood clot enlarges, surgical intervention will be necessary!

Reply Date: 2016/06/01

More Info

Understanding intracranial hemorrhage, especially in elderly patients, is crucial given the unique risks and complications that arise in this demographic. Your grandmother's situation is indeed serious, and it reflects the complexities involved in managing head injuries in older adults.

When an elderly person falls and sustains a head injury, the risk of intracranial hemorrhage increases significantly. This is due to several factors, including the natural aging process, which can lead to a reduction in brain volume and an increase in the fragility of blood vessels. In your grandmother's case, the presence of a 5 cm hematoma indicates a substantial amount of bleeding within the skull, which can lead to increased intracranial pressure and potentially life-threatening complications.

The immediate treatment for intracranial hemorrhage often involves stabilizing the patient and monitoring their neurological status closely. In your grandmother's case, the fact that she was initially able to converse and interact is a positive sign, but the subsequent confusion and hallucinations indicate that her condition may be deteriorating. These symptoms can arise from increased pressure on the brain, which can affect cognitive function and lead to altered mental states.

The decision to keep her in the intensive care unit (ICU) is standard practice for patients with significant intracranial hemorrhages, especially when there are concerns about their neurological status. The medical team will likely be monitoring her vital signs, neurological responses, and any signs of further bleeding. The use of restraints, as you mentioned, is often a necessary measure to prevent patients from injuring themselves, especially if they are disoriented or agitated.

Regarding treatment options, the medical team may consider several approaches depending on her stability and the evolution of her condition. If the hematoma does not resolve on its own or if her symptoms worsen, surgical intervention may be necessary to relieve pressure on the brain. This could involve a craniotomy to remove the blood clot and allow for better brain function.

In terms of recovery, it's essential to understand that the healing process can be slow, particularly in elderly patients. Factors such as age, overall health, and the extent of the injury all play a role in recovery outcomes. While some patients may experience significant improvement, others may face long-term challenges, including cognitive deficits or physical disabilities.

As for your family's emotional response, it's entirely understandable to feel overwhelmed and uncertain during this time. It is important to communicate openly with the healthcare team about your concerns and to seek clarity on her condition and prognosis. They can provide you with the most accurate information based on her specific situation and guide you on what to expect moving forward.

In summary, your grandmother's condition is serious, and while there is a possibility for improvement, it is essential to remain vigilant and supportive. The medical team will continue to assess her condition and determine the best course of action. It is also vital for your family to take care of your emotional well-being during this challenging time, as navigating the complexities of healthcare for an elderly loved one can be incredibly taxing.

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