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Aneurysmal subarachnoid hemorrhage — RCPSC IM MCQ

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HardNeurologyAneurysmal subarachnoid hemorrhageRCPSC IM

A 56-year-old has aneurysmal subarachnoid hemorrhage confirmed on CT and angiography. While urgent aneurysm occlusion is arranged, which medication reduces delayed cerebral ischemia?

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Correct answer: D — Start enteral nimodipine during aneurysm care

The best answer is “Start enteral nimodipine during aneurysm care”. Nimodipine improves neurologic outcome by reducing delayed cerebral ischemia after aneurysmal SAH. Anticoagulation and profound hypotension are hazardous; prolonged antifibrinolysis and routine indefinite antiseizure therapy are not substitutes for aneurysm securing and neurocritical care. Care also includes neurocritical monitoring, maintenance of cerebral perfusion and surveillance for hydrocephalus, seizures and delayed ischemia.

Reference: Canadian Stroke Best Practices, emergency management of intracerebral hemorrhage: https://www.strokebestpractices.ca/recommendations/management-of-intracerebral-hemorrhage/emergency-management-of-intracerebral-hemorrhage