A 35-year-old motorcyclist is brought in after a collision. He has a GCS of 7 (E2V2M3), BP 130/80, HR 90. Head CT shows a biconvex (lenticular) hyperdense collection in the temporal region with 1.5 cm midline shift. There is a lucid interval documented by the ambulance team. The immediate management is:
- A Emergency surgical evacuation (craniotomy/burr holes) ✓
- B Intravenous mannitol and intubation for ICP control
- C Urgent CT angiography to identify bleeding vessel
- D Neurological observation in HDU for 6 hours
Correct answer: A. Emergency surgical evacuation (craniotomy/burr holes)
Explanation
A biconvex (lenticular) haematoma with midline shift > 5 mm or haematoma thickness > 15 mm or GCS deterioration (lucid interval followed by deterioration) is an acute epidural haematoma (EDH) — a neurosurgical emergency requiring immediate craniotomy and haematoma evacuation. The typical mechanism is rupture of the middle meningeal artery from a temporal bone fracture. Mannitol may be used as a temporising measure but does not substitute for surgery. Observation alone is inappropriate with significant midline shift.
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.