<prompt> You are surgeon posted at CHC. A patient of head injury come to you with rapidly deteriorating sensorium and progressive dilation and fixation of pupil. Neurosurgeon and CT scan is not available. You decide to make a burr hole to emergently relieve the intracranial pressure. Which of the following sites will you chooseIn the temporal region contralateral to the side of pupilary dilatationIn the midline if both pupils are equal or it is not known which side dilated first.In the left temporal region if no localising sign is foundRefer to higher centre if both pupils are equal or it is not known which side delated first.  <response>: Burr Hole to emergently relieve the intracranial pressure should be done in the left temporal region if no localising sign is found, to evaluate and decompress the dominant hemisphere Choice of side for initial Burr Hole Sta with a temporal Burr hole on the side Ipsilateral to a blown pupil: This will be on the correct side in 85 of epidural hemorrhages and other extra - axial mass lesions If both pupils are dilated, used the side of the first dilating pupil if known If pupils are equal, or it is not known which side dilated first, place on side of obvious external trauma If no localisation clues, place hole on left side to evaluate and decompress the dominant hemisphere Ref: Ramamuhi and PN Tandons Textbook of Neurosurgery 3rd edition Vol-1 Pgno :442 