What is the best next step in management for a 12‑year‑old girl who fell, has loss of consciousness, vomiting, somnolence, head hematoma, left‑side weakness with lateralizing signs, and CT showing an acute epidural hematoma with midline shift?

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Last updated: February 16, 2026View editorial policy

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Immediate Surgical Evacuation is Required

This patient requires emergency craniotomy for hematoma evacuation immediately after airway protection via rapid-sequence intubation. 1, 2

Rationale for Immediate Surgical Intervention

This 12-year-old presents with an absolute indication for urgent neurosurgical decompression: an acute epidural hematoma with midline shift, accompanied by deteriorating neurological status (loss of consciousness, repeated vomiting, somnolence, focal weakness, and lateralizing signs). 1, 2

Emergency surgical evacuation of symptomatic extradural hematoma is mandatory irrespective of location. 1, 2 The presence of:

  • Midline shift (indicating significant mass effect) 1
  • Focal neurological deficit (left limb weakness) 1, 2
  • Altered consciousness with vomiting 2
  • Lateralizing signs 1

These findings collectively represent rapid neurological decline requiring immediate decompression. 1

Critical Timing Consideration

Every minute of delay in decompression increases the risk of transtentorial herniation and brain-stem death; this is a neurosurgical emergency. 1 Emergency surgical evacuation reduces mortality from approximately 80% to 27% and increases independent functional outcome from 20% to 53%. 1 Shorter time from injury to surgical evacuation is directly associated with better neurological outcomes. 1

Correct Sequence: Airway FIRST, Then Surgery

Before proceeding to the operating room, the airway must be secured via rapid-sequence endotracheal intubation with mechanical ventilation. 2 This patient has:

  • Repeated vomiting (high aspiration risk) 2
  • Altered consciousness/somnolence (inability to protect airway) 2
  • Likely GCS ≤8 based on clinical description 2

Delaying intubation to rush to surgery can cause aspiration, hypoxemia, or hypercarbia, which worsen neurological outcomes; therefore intubation must precede surgical evacuation. 2

During intubation, maintain systolic blood pressure >110 mmHg using vasopressors (phenylephrine or norepinephrine), as even a single episode of SBP <90 mmHg markedly worsens neurological outcomes. 2 End-tidal CO₂ monitoring must confirm tube placement and maintain PaCO₂ at 35-40 mmHg to avoid cerebral vasoconstriction. 2

Why Other Options Are Incorrect

Option C (Admit and observe) is contraindicated. Conservative management is only appropriate for asymptomatic patients with small EDH (<40mm), minimal midline shift (<6mm), and GCS 13-15. 3, 4 This patient has symptomatic EDH with midline shift, neurological deterioration, and focal deficits—all absolute contraindications to observation. 1, 2

Option D (Repeat CT after 12 hours) is dangerous and inappropriate. This patient is already demonstrating clinical deterioration with mass effect on imaging. Waiting 12 hours risks irreversible herniation and death. 1 Repeat imaging is only indicated for stable, asymptomatic patients being managed conservatively. 3

Option B alone (Intubate and secure airway) is incomplete. While airway protection is the immediate first step, it is not the definitive management. 2 The airway must be secured as preparation for emergency craniotomy, not as standalone treatment. The mass lesion causing brain compression requires surgical evacuation. 1, 2

Post-Operative Management

After hematoma evacuation:

  • Intracranial pressure monitoring is mandatory given the pre-operative altered consciousness and focal deficits 2
  • Maintain cerebral perfusion pressure 60-70 mmHg 2
  • Continue mechanical ventilation with normocapnia 2

Common Pitfall to Avoid

Do not delay surgery for "stabilization" beyond securing the airway and achieving hemodynamic targets. 2 High-dose corticosteroids have no role in traumatic brain injury management and should not be administered. 1 External ventricular drains are ineffective and unsafe as primary treatment for mass lesions; they are only indicated post-operatively if hydrocephalus develops. 1

References

Guideline

Emergency Craniotomy for Acute Epidural Hematoma: Evidence‑Based Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Management of Traumatic Head Injury

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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