This protocol applies to neurologically unstable patients who present with a large chronic subdural hematoma and profound neurological symptoms with active neurological decompensation — a time-sensitive scenario with a well-defined standard-of-care intervention.
The patient is neurologically unstable, with a large chronic subdural hematoma causing or accompanied by profound neurological symptoms and ongoing decompensation. This presentation defines an urgent subgroup in which watchful waiting is not appropriate.
The evidence-based approach for this scenario centres on an emergent surgical intervention targeting the hematoma directly. The complete structured regimen — procedural details, sequencing, and post-operative management — is available in the full protocol below.
For decompensating patients presenting with profound neurological symptoms, emergent surgical drainage is the standard of care.
Surgical drainage improves neurological status and prevents further decline in patients with large cSDHs.