A 68-year-old hypertensive man presents with sudden decreased consciousness. CT shows a 45 ml left putaminal intracerebral hemorrhage with intraventricular extension and 8 mm midline shift. GCS is 9. What is the recommended management?
- A Emergency craniotomy and hematoma evacuation
- B Conservative management with blood pressure control and ICP monitoring ✓
- C Stereotactic aspiration of the hematoma
- D External ventricular drain placement only
Correct answer: B. Conservative management with blood pressure control and ICP monitoring
Explanation
The STICH II trial showed no benefit from early surgery over conservative management for spontaneous supratentorial ICH with lobar or deep hemorrhage. Current guidelines recommend conservative management with blood pressure control, ICP monitoring, and supportive care for most supratentorial ICH. Surgery is considered for cerebellar hemorrhage >3 cm, hydrocephalus, or clinical deterioration with accessible superficial hemorrhage.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.