Chronic Subdural – Burr Hole Drainage — SCE Neurology MCQ

Correct answer: B — Urgent neurosurgical evacuation, usually through burr-hole drainage with a drain

The best answer is “Urgent neurosurgical evacuation, usually through burr-hole drainage with a drain”. Neurological deficit and substantial mass effect require operative decompression; medical observation is reserved for carefully selected minimally symptomatic collections. “Dexamethasone alone with outpatient interval imaging” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Therapeutic anticoagulation to prevent cortical venous thrombosis” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Lumbar puncture to reduce intracranial pressure before referral” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Observation because chronic blood products cannot cause acute deterioration” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: ARISE I consensus statement on chronic subdural haematoma: https://pubmed.ncbi.nlm.nih.gov/37126923/