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Neurology in older adults: subdural haematoma — SCE Neurology MCQ

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HardSpecial GroupsNeurology in older adults: subdural haematomaSCE Neurology

A 74-year-old taking apixaban for atrial fibrillation attends 10 hours after a low-energy fall with a minor head impact. He has GCS 15, no loss of consciousness, amnesia, vomiting, focal deficit or other standard indication for immediate CT. Which NICE timing target applies when imaging is considered because of the anticoagulant?

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Correct answer: D — CT head within 1 hour of the current emergency-department presentation

For a person with head injury who has no other indication for CT but is taking an anticoagulant, NICE advises considering CT within 8 hours of injury. Because this patient presents more than 8 hours after the injury, the scan should be considered within 1 hour of presentation. Apixaban is a direct oral anticoagulant and falls within that recommendation. A normal examination does not remove the anticoagulant-related risk, and observation or later imaging is not a substitute for applying the specified CT timing decision.

Reference: NICE NG232, Head injury — recommendations: https://www.nice.org.uk/guidance/ng232/chapter/recommendations