A 22-year-old motorcyclist sustains a head injury. On arrival he is confused (E3V4M5 = GCS 12). CT head shows a biconvex (lenticular) hyperdense lesion over the right temporal region with 1 cm midline shift. Pupils are equal and reactive. The most appropriate management is:
- A Conservative management with serial CT scans
- B Urgent surgical evacuation (craniotomy) ✓
- C IV mannitol and hyperventilation only
- D IV corticosteroids to reduce oedema
Correct answer: B. Urgent surgical evacuation (craniotomy)
Explanation
A biconvex (lenticular) hyperdense extradural haematoma with significant midline shift (greater than 5 mm) or volume greater than 30 mL is an indication for urgent surgical evacuation, even if the patient is currently conscious. The classic lucid interval may be present, but deterioration from arterial bleeding (typically middle meningeal artery) can be rapid. Mannitol and hyperventilation are temporising measures only. Corticosteroids have no role in traumatic brain injury.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.