American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is a specific indication for neurosurgical evacuation of a hematoma?

1. Hematomas located in the cerebral cortex

2. Hematomas located in the cerebellum

3. Hematomas smaller than 2 cm

4. Hematomas in the brainstem

The correct answer is: Hematomas located in the cerebellum

Neurosurgical evacuation of a hematoma, particularly one located in the cerebellum, is indicated due to the unique anatomical and functional significance of this area. Hematomas in the cerebellum can lead to increased intracranial pressure and can quickly affect vital functions, including coordination and balance. Additionally, cerebellar hematomas can cause brainstem compression, which can be life-threatening. Because of these potential complications, prompt surgical intervention is often necessary. Cerebellar hematomas may require evacuation even if they are not large, as their location can disproportionately affect neurological function and lead to acute deterioration in the patient's condition. This is in contrast to hematomas located in the cerebral cortex or other areas, where smaller size may sometimes allow for non-surgical management unless they demonstrate significant mass effect or symptoms. Understanding the critical risks associated with cerebellar hematomas helps justify the decision for neurosurgical intervention in these cases.