American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the minimum diameter of a cerebellar hematoma that typically warrants surgical evacuation?

1. 2 cm

2. 3 cm

3. 4 cm

4. 5 cm

The correct answer is: 3 cm

The typical threshold for considering surgical evacuation of a cerebellar hematoma is around 3 cm in diameter. This is based on clinical guidelines and studies that indicate that hematomas of this size can cause significant mass effect on the cerebellum and brainstem, leading to increased intracranial pressure and potential neurological deficits. When a hematoma reaches this diameter, the risk of deteriorating clinical status rises, which often necessitates intervention to prevent complications such as brain herniation or permanent neurological damage. In cases where the hematoma is less than 3 cm, conservative management may be appropriate, focusing on monitoring and supportive care. However, once the size exceeds this threshold, the likelihood of symptomatic issues increases, making surgical evacuation more critical to alleviate pressure and restore normal brain function. As such, 3 cm is recognized as a vital point where intervention becomes necessary.