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A 48-year-old with a complete MCA territory infarct develops worsening obtundation and 6 mm of midline shift on CT at hour 36. Which intervention has demonstrated mortality benefit per pooled DESTINY/DECIMAL/HAMLET data?
Decompressive hemicraniectomy within 48-72 hours
High-dose IV methylprednisolone
Therapeutic hypothermia to 32 degrees C
Repeat IV alteplase
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Correct Answer:
Decompressive hemicraniectomy within 48-72 hours
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