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SAH Hydrocephalus — RACP Adult Medicine MCQ

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ModerateNeurologySAH HydrocephalusRACP Adult Medicine

A 55-year-old man with SAH develops progressive drowsiness on day 3. CT brain shows enlarging ventricles (hydrocephalus) without new haemorrhage. What is the most appropriate acute management?

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Correct answer: D — EVD placement

Acute hydrocephalus complicates ~20% of SAH cases and presents with declining consciousness. External ventricular drainage (EVD) provides immediate CSF diversion and ICP monitoring. Some patients develop chronic hydrocephalus requiring ventriculoperitoneal (VP) shunt. EVD placement is an emergency neurosurgical procedure.

Reference: Stroke Foundation Australia – 2024 – SAH Complications; AHA/ASA 2023