With aging, the brain undergoes progressive atrophy and decreases in size by about 10 percent between the ages of 30 and 70 years. 10 Subtle changes in cognition, memory, and data acquisition may confound the emergency physician's evaluation of the elderly patient's mental status. When evaluating the patient's mental status during the neurologic examination, it would be a grave error to assume that alterations in mental status are due solely to any underlying dementia or senility.
Elderly persons suffer a much lower incidence of epidural hematomas than the general population. 10 This has been attributed to the relatively more dense fibrous bond between the dura mater and the inner table of the skull in older individuals. There is, however, a higher incidence of subdural hematomas in elderly patients. As the brain mass decreases with advancing age, there is greater stretching and tension of the bridging veins that pass from the brain to the dural sinuses. The increased "dead space" within the skull may delay symptoms of intracranial bleeding. 91° More liberal indications for computed tomographic (CT) scanning are justified.
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