An older patient with a history of anticoagulant use presents with a hematoma and neurological symptoms after a fall. What is the most likely cause of these symptoms?

In the context of an older patient with a history of anticoagulant use who presents with a hematoma and neurological symptoms after a fall, the most likely cause of these symptoms is subdural hematoma.

Subdural hematomas often occur in older adults, especially those on anticoagulants, due to the increased risk of bleeding and the atrophy of the brain that makes the bridging veins more susceptible to tearing during minor trauma, such as a fall. The symptoms can develop either acutely, often presenting within days or weeks after the injury, particularly if it was a more significant impact, or chronically, especially in cases where the bleeding is slow. The age and anticoagulant history of the patient heighten the risk factors for this condition.

While intracranial hemorrhage could also be a consideration, subdural hematomas are more prevalent in older adults, especially when accounting for the likely mechanism of injury from a fall. Chronic subdural hematomas refer specifically to those that have existed for a longer period before symptoms present, and brain contusions generally involve direct injury to the brain tissue itself rather than bleeding into the space between the brain and its protective covering.