skip to main content

Thalamic Haemorrhage with Hydrocephalus — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCerebrovascular DiseaseThalamic Haemorrhage with HydrocephalusSCE Neurology

A 55-year-old hypertensive man presents with sudden onset of right hemiparesis and hemisensory loss. CT head shows a left thalamic haemorrhage extending into the third and lateral ventricles with early hydrocephalus. He is becoming drowsy (GCS 12). What intervention is most likely to be beneficial?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — External ventricular drain insertion

Intraventricular extension of intracerebral haemorrhage with hydrocephalus is an indication for external ventricular drain (EVD) insertion to relieve obstructive hydrocephalus and monitor ICP. Surgical evacuation of deep (thalamic/basal ganglia) haemorrhages is not generally beneficial. A: Decompressive craniectomy is for supratentorial hemispheric oedema, not deep haemorrhage. C: Surgical evacuation of deep haemorrhages has no proven benefit (STICH trials). D: Intraventricular thrombolysis (CLEAR III trial) showed reduced mortality but no functional benefit. E: Lumbar drainage is contraindicated with obstructive hydrocephalus.

Reference: RCP National Clinical Guideline for Stroke (2023); STICH II Trial