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Cerebellar Haemorrhage – Surgical Indication — SCE Neurology MCQ

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HardCerebrovascular DiseaseCerebellar Haemorrhage – Surgical IndicationSCE Neurology

A patient with a 3.5 cm cerebellar haemorrhage becomes drowsy, with fourth-ventricle compression and acute hydrocephalus. What is the urgent definitive intervention?

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Correct answer: C — Immediate neurosurgical decompression and haematoma evacuation

The best answer is “Immediate neurosurgical decompression and haematoma evacuation”. Neurological deterioration, brainstem compression and obstructive hydrocephalus from cerebellar haemorrhage require emergency posterior-fossa decompression; ventricular drainage alone may be insufficient. “Mannitol alone with outpatient observation” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Intravenous thrombolysis” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Whole-brain radiotherapy” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Lumbar puncture to relieve hydrocephalus” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: NICE NG128 stroke and TIA recommendations: https://www.nice.org.uk/guidance/ng128/chapter/recommendations