Mild Headache in Surgery — 72yo Man | Neurosurgery | SMLE Q#18412

SMLE Question #18412

Surgery Neurosurgery

Objective: OBJ-310

A 72-year-old man is brought to the ED after a low-speed motor vehicle collision. He is confused with a mild headache and has new left-sided arm and leg weakness. He is not taking anticoagulants. Vital signs: T 36.8°C, BP 158/86 mmHg, HR 92/min, RR 16/min, SpO2 97% on room air. Neurologic exam: GCS 14 (E4 V4 M6) with 4/5 strength in the left upper and lower extremities. Non-contrast CT head shows a right frontoparietal crescent-shaped extra-axial hyperdensity with mass effect and 7 mm midline shift, consistent with acute subdural hematoma. What is the most appropriate next step in management?

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