A 40-year-old man is involved in a road traffic accident. On arrival, GCS is 9 (E2V3M4). CT head shows a 30 mL extradural haematoma (EDH) with 8 mm midline shift and a lens-shaped hyperdense collection at the right temporoparietal region. The immediate management is:

• A ICP monitoring and mannitol infusion with 24-hour repeat CT
• B Observe in HDU and reassess GCS every hour
• C Emergency surgical evacuation (craniotomy) ✓
• D Intubation, ventilation and decompressive craniectomy

Explanation

Surgical indications for EDH per NICE and BTIF guidelines: haematoma volume >30 mL, OR clot thickness >15 mm, OR midline shift >5 mm, regardless of GCS — or any EDH in a patient with GCS deterioration. This patient has 30 mL, 8 mm midline shift, and GCS 9 — clear indications for emergency evacuation by craniotomy. EDH managed early has excellent outcomes as the brain injury is usually from mass effect rather than intrinsic damage. Delayed surgery risks irreversible Cushing's triad and herniation.

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.