Head Injuries in Elderly: When to Seek Medical Attention

Head injury

I would like to consult a doctor.
My grandmother, who is 80 years old, fell at home on the morning of May 18, 2022, around 9 AM.
She hit her head and developed a bump.
When we helped her up, she mentioned that the area where she was hit felt numb and was slightly painful when pressed.
Family members suggested that we observe her for any symptoms.
On May 18, 2022, she did not experience any nausea, runny nose, or other symptoms.
I applied ice to the affected area every 20 minutes, followed by a 20-minute rest, and repeated this several times.
The swelling noticeably decreased.
On May 19, 2022, I continued to ice her head, and in the morning, there were no unusual signs.
However, on the evening of the same day, around 7 PM, I noticed some bruising and swelling around her eyelids.
Doctor, what solutions do you recommend? Should I take her to the hospital (she has not been to a hospital yet)? Is this a normal occurrence? Could this condition be serious? How many days should we observe her before feeling reassured?

Jia Jie, 10~19 year old female. Ask Date: 2022/05/19

Dr. Zhang Junwei reply Neurosurgery

Purple eyelids indicate a bruise.
It is important to check for symptoms such as headache, dizziness, nausea, or vomiting; if any of these are present, medical attention should be sought.

Reply Date: 2022/05/19

More Info

When an elderly person experiences a head injury, such as your grandmother did, it is crucial to monitor her closely for any signs of complications. Given her age and the nature of the injury, there are specific guidelines to follow regarding when to seek medical attention.

Initial Assessment and Home Care
In the immediate aftermath of a head injury, it is essential to assess the individual for any concerning symptoms. These may include:
- Loss of consciousness, even briefly
- Persistent headache or worsening pain
- Nausea or vomiting
- Dizziness or balance issues
- Confusion or disorientation
- Seizures
- Unusual behavior or lethargy
In your grandmother's case, she initially reported a "tingling" sensation and some pain at the impact site, which is not uncommon. The application of ice to reduce swelling is a standard practice and can be beneficial in the first 24-48 hours post-injury. However, the appearance of bruising around the eyes (often referred to as "raccoon eyes") can indicate a more serious issue, such as a skull fracture or intracranial bleeding.

When to Seek Medical Attention
Given that your grandmother is 80 years old and has sustained a head injury, it is advisable to err on the side of caution. Here are some guidelines for when to seek medical attention:
1. Worsening Symptoms: If she develops any of the concerning symptoms listed above, especially confusion, persistent headache, or any signs of neurological deficits (like weakness in limbs or difficulty speaking), you should seek immediate medical attention.

2. Changes in Consciousness: If she becomes increasingly drowsy, difficult to wake, or shows any signs of altered consciousness, this is a medical emergency.

3. Visible Bruising: The development of bruising around the eyes, especially if accompanied by swelling, should prompt a visit to the doctor. This could indicate a more severe injury that requires imaging studies, such as a CT scan, to rule out bleeding or fractures.

4. Persistent Pain: If the pain at the injury site worsens or does not improve with over-the-counter pain relief, a medical evaluation is warranted.

Follow-Up Care
If your grandmother's symptoms remain stable and she does not exhibit any concerning signs, you may choose to continue monitoring her at home for a few days. However, it is essential to keep a close watch on her condition. If you notice any changes or if her symptoms worsen, do not hesitate to take her to the hospital.

Conclusion
In summary, while some bruising and swelling can be normal after a head injury, the presence of significant bruising around the eyes and any changes in her condition warrant a medical evaluation. Given her age and the potential for complications, it is always better to be cautious. If in doubt, consult with a healthcare professional for guidance. Your grandmother's health and safety are paramount, and seeking medical advice can provide peace of mind and ensure appropriate care.

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