A 22-year-old man is brought in after a road traffic accident. GCS on arrival is 9 (E2V3M4). CT head shows a biconvex (lenticular) hyperdense extradural haematoma of 35 mL with 8 mm midline shift and a lucid interval was reported by witnesses. The next step in management is:
- A Urgent craniotomy and evacuation of the haematoma ✓
- B IV mannitol and hyperventilation then repeat CT in 6 hours
- C ICP monitoring and conservative management
- D Decompressive craniectomy
Correct answer: A. Urgent craniotomy and evacuation of the haematoma
Explanation
An extradural haematoma >30 mL, thickness >15 mm, or midline shift >5 mm requires immediate surgical evacuation regardless of GCS. The classic lucid interval followed by deterioration and a biconvex haematoma (typically from middle meningeal artery rupture) is a neurosurgical emergency; urgent craniotomy and clot evacuation is life-saving and must not be delayed for conservative measures.
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.