Beware of the Anticoagulated Elderly with Minor Head Injury

A 69-year-old man first presented to the emergency department after a fall. He had no history of loss of consciousness or vomiting. He sustained a 3 cm long laceration over the right occipital region of the head. There was no fracture in the X-rays of the skull. He was on warfarin because of cardiac problem. He was discharged after suturing. He re-attended the next morning because of left sided weakness. Non-contrast brain computed tomogram showed acute subdural haematoma. Burr holes were performed subsequently. Special precautions should be undertaken in managing the elderly with minor head injury, with a lower threshold for computed tomography and coagulation profile studies.