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Aneurysmal SAH Management — RACP Adult Medicine MCQ

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ModerateNeurologyAneurysmal SAH ManagementRACP Adult Medicine

A 35-year-old woman presents with sudden severe headache during sexual intercourse. She briefly loses consciousness and has a GCS of 14 on arrival. CT brain shows subarachnoid blood in the basal cisterns. CT angiography reveals a 7 mm anterior communicating artery aneurysm. What is the most appropriate definitive management?

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Correct answer: A — Endovascular coiling of aneurysm

Ruptured anterior communicating artery aneurysm causing SAH requires definitive aneurysm treatment to prevent rebleeding (risk ~40% within 4 weeks). The ISAT trial showed endovascular coiling is associated with better outcomes than surgical clipping for most posterior circulation and anterior circulation aneurysms amenable to either approach. Nimodipine is given for vasospasm prevention but is not definitive treatment.

Reference: Stroke Foundation Australia – 2024 – SAH Management; ISAT Trial