Cerebellar infarct with hydrocephalus — SCE Neurology MCQ
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Correct answer: A — Urgent neurosurgical decompression with ventricular drainage when required
The best answer is “Urgent neurosurgical decompression with ventricular drainage when required”. Posterior-fossa swelling can obstruct CSF flow and compress the brainstem. Falling consciousness with hydrocephalus is a neurosurgical emergency requiring decompression, with ventricular drainage used in the operative plan rather than as an isolated delaying measure. The alternatives “Isolated ventricular drainage without assessing posterior-fossa decompression”, “Repeat CT imaging after another 24 hours despite deterioration”, “Antiplatelet loading as treatment for posterior-fossa swelling”, “Lumbar puncture to relieve obstructive hydrocephalus” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.
Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/