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Hyperkalemia ECG changes — USMLE Step 3 MCQ

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HardEmergency MedicineHyperkalemia ECG changesUSMLE Step 3

A 60-year-old with spontaneous intracerebral hemorrhage has no clinical seizure. Mental status and neurologic examination are stable, and there are no suspicious episodic movements. Which antiseizure strategy is appropriate?

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Correct answer: D — Use neurologic monitoring without routine prophylactic antiseizure medication

The best answer is “Use neurologic monitoring without routine prophylactic antiseizure medication”. AHA/ASA guidance does not support prophylactic antiseizure medication after spontaneous ICH when there is no evidence of seizures, because it does not improve long-term seizure control or functional outcome. Clinical or electrographic seizures should be treated, and unexplained fluctuating mental status may warrant EEG.

Reference: 2022 AHA/ASA Guideline for Spontaneous Intracerebral Hemorrhage: https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-patients-with-spontaneous-intracerebral-hemorrhage/top-things-to-know