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Delayed Cerebral Ischaemia — RACP Adult Medicine MCQ

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HardNeurologyDelayed Cerebral IschaemiaRACP Adult Medicine

A 60-year-old man with aneurysmal SAH (Hunt-Hess Grade 3) undergoes coiling on day 1. On day 7, he develops new confusion and left hemiparesis. CT brain shows no rebleed. Transcranial Doppler shows elevated flow velocities in the right MCA (>200 cm/s). What is the most likely complication?

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Correct answer: D — Delayed cerebral ischaemia from vasospasm

New neurological deficit on days 4–14 after SAH with elevated TCD velocities (>200 cm/s indicates severe vasospasm) and no rebleed on CT is delayed cerebral ischaemia (DCI) from vasospasm. Management: continue nimodipine, induced hypertension (triple-H therapy or targeted BP augmentation), and consider endovascular intervention (intra-arterial verapamil or balloon angioplasty).

Reference: Stroke Foundation Australia – 2024 – SAH Vasospasm; AHA/ASA 2023