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Subdural hematoma — USMLE Step 2 CK MCQ

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HardSurgerySubdural hematomaUSMLE Step 2 CK

A 72-year-old taking apixaban falls down stairs. After anticoagulant reversal, CT volumetry shows a 32-mL acute convexity subdural hematoma with mass effect. He opens his eyes spontaneously, is confused, and obeys commands. Which definitive management is indicated?

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

Reveal the answer and explanation

Correct answer: A — Perform urgent craniotomy with complete evacuation before neurological deterioration occurs

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

B is correct: ACS traumatic-brain-injury guidance classifies an intracranial hematoma above 25 mL as large and recommends evacuation before neurological deterioration; acute subdural hematoma generally requires a sufficiently large craniotomy for complete evacuation. A, D, and E allow a reassuring current examination to delay source control despite a large space-occupying lesion. C may temporize intracranial hypertension but cannot remove the hematoma.

Reference: American College of Surgeons: best practices guidelines for traumatic brain injury. https://www.facs.org/media/vgfgjpfk/best-practices-guidelines-traumatic-brain-injury.pdf