Q:

A 55 year old chronic alcoholic with sustains no obvious injuiry

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A 55 year old chronic alcoholic with known hepatic cirrhosis has been on a heavy bout of alcohol the night before and was brought home by friends after falling several times in the pub. While being taken up the stairs to his bedroom he falls down the flight of 5 steps but sustains no obvious injuiry. His wife calls the ED the next day because she could not rouse him in the morning. He is brought in in a comatose state and both pupils appear dilated. Skull vault XR appears normal.


  1. Hepatic encephalopathy
  2. Intracerebral hematoma
  3. Brain stem injury
  4. Extradural hematoma
  5. Chronic subdural hemorrhage
  6. Despressed skull fracture
  7. Vertibrobasilar ischemia
  8. Acute subdural hematoma

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The key is H. Acute subdural hematoma. [Acute subdural hemotoma, typical history of alcholics, falls and usually debilliated or elderly, hepatic cirrhosis increases coagulopathy and chances for bleed].

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