Unsteadiness And Clumsiness — Could There Be Something More Than A Minor Stroke? A CASE STUDY TO REMEMBER

ABSTRACT

Unsteadiness and falls in the elderly are a common complaint in primary care and their incidence is expected to increase as the population ages. These patients are physiologically less able to withstand traumatic forces than their younger counterparts and are thus more prone to morbidity and mortality. Aside from intrinsic and extrinsic risk factors, there may be more sinister pathologies underlying these events. We report a case of an elderly gentleman who presented with unsteadiness, clumsiness and recurrent falls. The patient’s son brought to our attention subtle suspicious findings which eventually led to further evaluation. The patient was found to have had bilateral acute on chronic subdural haemorrhages with associated mass effect, underwent emergent decompression surgery and showed marked functional recovery. We review the incidence and outcomes of recurrent falls in the elderly, as well as the incidence, risk factors and varied presentations of subdural haemorrhage in the primary care setting. The case also reminds clinicians of the tendency to overlook and undermanage such patients with seemingly “minor” falls, and the value of family members’ inputs during consultation. It highlights the need for a high index of suspicion and the necessity of lower referral thresholds for further evaluation if indicated.