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If an older person, two or three weeks to a few months after bumping their head, becomes unsteady on their feet, slow, sleepy or weak on one side, get a head CT

  • High value
  • Evidence B
  • Buys life
  • For: Elderly relative at home, Age 60+
  • Costs a little
  • Takes some hours
  • No willpower

In a real emergency, call 911 first, then read this.

In plain words

After an older person bumps their head, blood usually collects only by the third week. They may be completely fine at the time of the knock, and may not even remember hitting their head. After surgery for this illness, the recurrence rate can reach 33% and the death rate can reach 32%. If you find an older person suddenly confused, floating when they walk, always wanting to sleep, or with one weak hand, first go back and ask whether they hit their head in the last two or three months, and then get a CT.

Cost

A head CT costs two or three hundred CNY.

What you get

The Chinese Medical Association's neurosurgery branch and others published the Chinese Expert Consensus on Drug Treatment of Chronic Subdural Hematoma (《慢性硬膜下血肿药物治疗中国专家共识》). A chronic subdural hematoma is a pool of blood that slowly collects between the membranes around the brain. Professionally it is described as a chronic space-occupying collection of blood between the arachnoid and the dura. It "usually forms in the third week after a head injury" and is more common in older people. After surgery the recurrence rate can reach 33% and the death rate 32%. For patients over 90, only 24% recover well overall. A systematic review: worldwide there are 3.39 to 39.1 new cases per 100,000 people per year, rising with age, and up to three times higher over 80. The most common causes are injury and falls, followed by long-term heavy drinking, medicines that stop blood clotting (anticoagulants) and violent injury. A geriatric medicine review: the presentation "typically includes confusion, cognitive decline, gait disturbance or sleepiness, and may resemble other geriatric syndromes"

Notes

There may be nothing wrong at all at the time of the knock, and the older person may not even remember hitting their head. So when the family finds "suddenly confused lately, floating when walking, always sleepy, one hand weak," first go back and ask whether they fell or hit their head in the last two or three months, and then get a CT. Don't put it straight down to "dementia" or "after-effects of the last stroke," because a wrong label causes delay. Older people taking aspirin, clopidogrel, warfarin or the newer oral anticoagulants are at higher risk, and so are people who drink heavily over a long time. For preventing falls, see §1.13 (train balance and leg strength).

Evidence grade
B : Supported by research but without a precise number, or based on small or single studies.
Sources
  1. Zhang J 等 (2021). Expert consensus on drug treatment of chronic subdural hematoma. Chinese Neurosurgical Journal, 7(1), 47. https://doi.org/10.1186/s41016-021-00263-z
  2. Dziho A 等 (2025). Global prevalence and incidence of chronic subdural hematoma: A systematic review. Brain and Spine, 5, 105893. https://doi.org/10.1016/j.bas.2025.105893
  3. Mathon B, Shotar E (2026). Diagnostic and therapeutic management of chronic subdural hematoma in elderly patients. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, 24(1), 30-41. https://doi.org/10.1684/pnv.2026.1274

Mentioned in

Translated from the Chinese original. Original book, section 13, tip 10. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer