Injuries: subdural haematoma in the elderly: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries: subdural haematoma in the elderly

Sample item

A 70-year-old chronic alcoholic recalls only a minor fall two weeks ago and now has headache and confusion. CT shows a crescentic collection over the convexity. Why is this age group prone to this lesion after trivial trauma?

ADural venous sinuses are easily lacerated by tiny linear fracturesBThinning of the skull makes the middle meningeal artery ruptureCWeak walls of berry aneurysms rupture with minor head movementDCerebral atrophy stretches the bridging veins so that they tear easily

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Cerebral atrophy stretches the bridging veins so that they tear easily

In old age and chronic alcoholism the brain shrinks, increasing the space between brain and dura, so the bridging veins are stretched and rupture with minimal acceleration or deceleration. The blood collects in the subdural space and spreads as a crescent over the hemisphere. The delay in symptoms suits a venous bleed.

Option by option

A. Dural venous sinuses are easily lacerated by tiny linear fractures
A sinus tear needs significant trauma, often with a fracture, and is not typical after a minor fall.
B. Thinning of the skull makes the middle meningeal artery rupture
An arterial bleed from the middle meningeal artery causes an extradural, biconvex haematoma.
C. Weak walls of berry aneurysms rupture with minor head movement
Aneurysm rupture causes subarachnoid haemorrhage rather than a convexity subdural collection.
D. Cerebral atrophy stretches the bridging veins so that they tear easily (correct)
Correct. Stretched bridging veins explain subdural bleeding after minor trauma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is D, Cerebral atrophy stretches the bridging veins so that they tear easily. In old age and chronic alcoholism the brain shrinks, increasing the space between brain and dura, so the bridging veins are stretched and rupture with minimal acceleration or deceleration.

Why is "Dural venous sinuses are easily lacerated by tiny linear fractures" not the answer?

A sinus tear needs significant trauma, often with a fracture, and is not typical after a minor fall.

Why is "Thinning of the skull makes the middle meningeal artery rupture" not the answer?

An arterial bleed from the middle meningeal artery causes an extradural, biconvex haematoma.

Why is "Weak walls of berry aneurysms rupture with minor head movement" not the answer?

Aneurysm rupture causes subarachnoid haemorrhage rather than a convexity subdural collection.

What concept does this question test?

It tests Injuries: subdural haematoma in the elderly in Forensic Medicine. The blood collects in the subdural space and spreads as a crescent over the hemisphere. The delay in symptoms suits a venous bleed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries: subdural haematoma in the elderly?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.