Mental status change followed by hypotension
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Brief History – Events two days prior to death
The patient was an elderly Caucasian man, nursing home patient who had an unwitnessed fall two days prior to death.
He was noted by the family to have mental status changes (somnolence and inability to bring dining utensils to his mouth while eating).
The family discussed this with nursing staff.
Nursing staff attributed the somnolence to “sundowning” although the patient previously was known always to be alert.
Events – day of death
The patient fell again on the day of death.
This was followed by cardiopulmonary collapse.
Paramedics were called and the patient was brought to the emergency room.
Radiography showed an intracranial, subarachnoid bleed with midline shift was noted. Extracranial blood was not noted in the study.
The working diagnosis by the hospital was ruptured cerebral aneurysm.
Operative drainage was deferred due to the patient’s age and clinical status.
The patient decompensated further that day and died.
This case is for independent assessment. There are no discussion questions.